Patients and Physicians Speak Out

Everything my pain management doctor had tried to get for me through a prior authorization has been denied. Now I’m just in constant pain and not able to do anything—much less enjoy the day. It’s ridiculous that all the sudden I have to have a prior authorization when they have covered it since 2006. It’s just outrageous what they are doing to us…I can’t afford to eat and purchase all the meds, so I have to make hard decisions.

I waited 6 days to get approved for Fentanyl patches for my cancer. My oncologist sent the prior authorization too. But these decisions are made on business days. So I had to suffer.

Prior authorization was very detrimental to a very close friend of mine. My friend has diabetes, severe hypertension, CKD-Stage 2, anemia and is legally blind secondary to diabetic retinopathy. In the spring of 2016 her primary care physician wrote a letter of prior authorization. He wanted to get her insurance company to approve a Catapres patch for treatment of her hypertension, because she could not tolerate the oral form of the medication without significant blood pressure fluctuations causing significant hypotension and hypertension. My friend was hospitalized that fall secondary to uncontrolled hypertension with edema and during that hospitalization they used the Catapres patch and her blood pressure finally stabilized. She has been using that medication ever since and now has well controlled blood pressure. It would seem the insurance company would have been wise to initially listen to the trained physician instead of paying for a hospitalization to come to the conclusion that my friend needed this medication.

I recently had a patient die due to needing a prior authorization for cefpodoxime axetil for a UTI.

Did a nephrectomy on a patient and sent him a prescription for pain medication—same ones he was getting in the hospital—and the pharmacy would not fill without a prior authorization from me. Patient had to go to the ER to get some pills. How much do you think that saved the insurance company?

I have had to make multiple calls and wait as long as 2 weeks trying to obtain authorization for an MRI when there were abnormal mammogram or pelvic sonogram findings. The patients become increasingly anxious about their condition and sometimes angry at me because they think I’m either withholding care or not concerned about their needs.