Patients and Physicians Speak Out

A court determined that my patient's antipsychotic medication was necessary for preventing life-threatening behavior. The patient's family told me that they couldn't afford the medication without [prior authorization] through insurance. Insurance would not give me an option that met the patient's needs fast enough to reduce the risk of life-threatening behavior. It's a bit disappointing that the word "life-threatening," coming from the prescribing physician, isn't enough to move the ball when working with these insurance companies [on prior authorizations]. After hours on the phone with the insurance and pharmacy, well after business hours, our best option was to use an un-tested medication and a GoodRx coupon. I did not sleep well that night.

I use a CPAP machine. My insurance denied one place and said to use another. So, I switched and immediately, and they declined the prior authorization. I can't sleep well without this equipment. I need it now, not whenever [the insurance company] approves it ages from now!

You cannot get the cost of a procedure before you get it. What was supposed to be $157 out of pocket after meeting deductible turned into $900! [My health insurer] would no longer authorize the same injection meds to knees I had been getting for years and had to settle with some half-ass stuff that didn’t even work. I need to know if I can afford something before I go in and do it - not a guesstimate! $157 turns into $900!

As a former Hospital Case Manager, it was very common for patients to be forced to remain in the hospital three extra days, while we waited on the insurance companies to review the chart and give authorization for discharge plans.

I have the gene that makes my cholesterol go extremely high and diet or exercise won’t help. I cannot take statins. I have tried it all. The only medicine that I can take is Repatha. I have been trying since this last October to get my Repatha refill…I am still in the waiting process; my cholesterol is now high again from the waiting game because of this prior authorization. These prior authorizations are putting people at high unnecessary health risks. Please help to put a stop to this method.

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.