I work in a headache clinic. Most of our treatments, at this time, are "off-label." When I prescribe a medication that is denied, the pharmacist tells the patient that I just have to do a prior auth and they can get it. I (and my MA who spends 50% of her time doing this) completes the prior auth, however, the prior auth requires a stratified treatment based on the medication's FDA-approved indication. I explain and even include studies to show the potential benefit for headaches. The prior auth is denied and the information given to the patient, either by the pharmacist or by the patient's insurance rep, is that a) I didn't do the prior auth correctly, or b) it was not the right medication for that patient. Both statements seriously erode the patient's trust in my knowledge and ability to help them.

First Name: 
Dr. Michael
Last Name: 
J.
State: 
State
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Have you ever gone to the pharmacy to fill a prescription only to be told that your insurance company requires approval before they'll cover your treatment? Have you ever waited for days, weeks, or months for a test or medical procedure to be scheduled because authorization from an insurer? Or are you a physician frustrated with the administrative headaches and their impact on your patient?

Prior authorization is a burden on patients and physicians alike. The process is confusing, time consuming, and — most importantly — can cause delays in patients receiving the care they need.

Please tell us know how prior authorization has impacted you. We are looking for stories from patients and physicians to highlight and draw attention to this issue that is impacting the health of so many Americans.