Patients and Physicians Speak Out

As a prescriber for children, I found the [prior authorization] system immoral. It caused delays in treatment for my kids with ADHD, severe anxiety and mood disorders, and PTSD. I always wrote in the comments space: “Congratulations! Once again you have - for no clinical reason - successfully interrupted and delayed essential treatment for my patient.”

I am constantly receiving automatic [prior authorization] denials for necessary medicines for my multiple sclerosis (MS) patients, with insurers denying [prescriptions] outright, or insisting I use their preferred and often inappropriate or less effective agents…and even refusing to approve routine imaging studies. Can spend hours trying to get through to a peer for discussion - am told that the call will be returned, and it never happens.

I hate [prior authorizations]. They are dangerous to patients, drain their funds (as they pay for meds until prior authorizations are approved), and steal time from my staff and the clinic, and me [.] Hours of non-billable time taken to take care of each medication for each patient [.]

Medicare Advantage […] delayed responding to my PCP’s request for a prior authorization for a referral to a dermatologist to assess a small pigmented mass on my ear. The delay of 5 months was due to my [insurer] subcontracting the approval process to [another company]. It was two more months before I had a malignant melanoma removed, and it had grown more than 3 times the original size. I am now receiving immunotherapy. This may not have been necessary if it had been addressed when it was first detected.

In my psychiatric practice, I help patients do well on a variety of medications that must be maintained indefinitely. Even though the need for maintenance is well established in the literature, insurance carriers require that [prior authorizations] be renewed yearly or more often, consuming a lot of my and my staff’s time. Obtaining [prior authorizations] takes at a minimum a few days, and sometimes, in the case of rejections, weeks. During that time, patients are not treated. Some have gotten much worse and ended up in the hospital. The delays put patients' lives at risk.

[The most frustrating aspect of prior authorization is] the delay in care or the denial of care that a patient needs. It should not be this difficult to provide care. Seems strange that someone not in the medical office with the patient is deciding what the patient needs or does not need after a physician that has had a decade of training makes a recommendation.