Prior Authorizations

Talk to any pharmacist and mention the word “Prior Authorization” to watch him/her instantly have a hemmoragic stroke.
Prior authorizations (PA, or TAR to some) are a way insurance companies say “Sure, we’ll cover this medication if you sing us a little song, dance us a little dance, and fill out these 100000 forms”. They are of course a huge topic for venting.
Most insurances (some state ran welfare programs for examples) are kind enough to let pharmacists handle all prior auth stuff. We get to fill out the paperwork, and we sign it and send it in for review. Now you may be thinking “Why is letting you do all the work ‘kind of them’?”. Well, when the patient is calling every 20 min asking if the insurance has covered their $2000 herpes cream, you want to have control of the situation; and delegating the paperwork task to some mininimum wage twat in the doctors office doesnt really put you in control of anything; so you are at the mercy of someone who can barely hold a conversation (let alone speak english clearly). Sad, i know, but 99% of doctor submitted prior auths are from the staff, not the doctor him/herself. Which leads into my bitch for the day:
One piss-poor aspect of some private insurance’s prior auth policies is that they demand that the doctor (or their representive) submit the prior auth.. I got the pleasure of talking to an insurance rep from one of the more well-known insurance plans this last week. Heres how the conversation sorta went:
Me: “Hi! Im The Angry Pharmacist from Drugstore Z, I wish to get a prior auth for patient John Doe for some ExpensiveDrug”.
Her: “Im sorry, but the doctors office or their staff have to call”
M: “But I have the diagnosis right here, its all faxed to me, I can send you a copy if you wish”
H: “Im sorry, but we do not accept prior auths from pharmacies”
(at this point im thinking that i’ll have a good story for this website)
M: “So it can be anyone at the doctors office”
H: “Correct”
M: “Even the Janitor if he/she wishes”
H: “Uhh, I suppose so, as long as they work for the doctor”
M: “So you’ll take a prior auth from someone with zero medical experience, who is just reading scribble from the chart and has no clue what the misprounounced words coming out of their mouth mean, yet you will NOT take the same information from someone with a Doctorate of Pharmacy who went to college for 7 years who has a medical history here of all medications tried and failed, as well as the necessary diagnosis information”
H: “Correct”
M: “May I ask what qualifications do you (meaning the prior auth team, not you personally) have to take this information”
H: “We are all licensed pharmacy technicians”
M: “So, if I am not qualified to give this information, and I am a licensed pharmacist, then obvously you all are not qualified to recieve this information because you are a technician. Do you have any high-schoolers there that are qualified to take this information?”
(I actually got a chuckle out of her with that one)
H: “Is there anything else I can help you with?”
M: “You never helped me in the first place”
*click*
Now I do know of a handful of doctors offices who have competant people doing prior auth stuff, so this rant doesnt really apply to you all. Its just the 2% that take up 99% of your day that make your blood boil. Ugh.

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2 Comments

  1. margaret says:

    You’re in a hurry to get this funny stuff written. I printed it off to the Pharm D I work for. She’ll love it.
    Mispellings: obviously, receive, mispronounced, Here’s.

  2. Dislike says:

    I was looking up the details behind prior authorization when I came across this blog.

    I agree that this PA is a lot of BS.

    But what I really hate is the way you spoke about people who are on medicaid.

    I’m on medicaid.

    I don’t have an STD, I speak English.

    I also speak Romanian and Greek.
    I’m white, college educated….my IQ is probably higher than yours..

    And I’m also sick. Very sick…

    I’ve been hospitalized 17 times in 3 years. I’ve had 3 emergency surgeries to save my life.

    It’s people like YOU who make the people like ME feel ashamed simply for being sick.

    I really hate the PA stuff…But I hate your attitude even more.

    I honestly hope somebody you love gets sick enough to need help…and that they have to deal with people like you.

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