Patients and Physicians Speak Out

I am a senior citizen and a military veteran. My wife recently had an increase in one of her medications ordered by her doctor. [The insurance company] refused to fill the prescription as written, leaving her at 2/3 of the required dosage. The doctor filed the form for a prior authorization and [the insurance company] refused to honor it. As I was preparing a detailed appeal letter, we received a second letter from [the insurance company] saying that they approved the increased dosage. Had they not made the approval, my next step would have been to have the doctor write a prescription for the most expensive alternative medicine available (some of them approach $1,000 for a 3-month supply). Here's where the prior authorization went wrong in this case. The reason for approval was a clause in the contract between [the insurance company] and [the pharmacy benefit manager] that says [the pharmacy benefit manager] must fill prescriptions using the cheapest available method. Prior authorization is not always about medical need - it's all about the money.

Yes! I had 3 doctors who wanted to file a class action suit against [my insurer] for playing doctor - they refused almost every script I tried to fill…

It took me a month just to get a blood glucose meter because of 'prior authorization.'

How corrupt is the chain of command when a doctor orders an MRI and the insurance denies the order? This applies to surgeries, lab, physical therapy, meds etc.

Due to a medication I take needing prior auth, I have at times been without the medication. I have had the medication denied, leaving me without it for over a month, to then get approved after excess paperwork was submitted by my physician. Despite being on this lifelong medication for over eight years, I still need a prior auth completed yearly which generally results in a period of time without the medication.

I work in a 24-bed Intermediate Care Facility for Individuals with Intellectual Disabilities. We haven't been able to provide at least 6 different medications to our clients due to the need for prior authorization. There are 9 medications that we got from our pharmacy, but may have to pay for as a facility pending prior authorization. These are not expensive medications for the most part and are essential for our clients' quality of life!