I save applying for prior authorizations until the end of the day to keep me from swearing out loud when there are patients around. My blood pressure goes up. In the last week I have had rejections (for rheumatology drugs) by a "bought and paid for" ER doc and radiologist.... I have to then write an appeal letter and "remind" the reviewer that these persons have rendered a verdict outside of their areas of expertise. I almost always get a rejection overturned, but the waste of time and energy is overwhelming to me—let alone the patient when that person needs care ASAP. Every year the insurers get deals on different drugs and then the whole tier action gets redistributed and folks who have been on certain meds for YEARS and in good control without side effects are thrown to the wolves and FORCED to get on a drug that may cause significant side effects. (My blood pressure is rising as I write this... I'd better stop now!!)