The Prior Authorization Scam

We have talked before about prior authorizations for diagnostic testing and referrals but how about meds.  This is a bigger scam and it is ONLY related to whether the insurance company has made a backroom deal with a pharmaceutical company.  It has very little or nothing to do with whether the drug is efficacious or not.  Now the insurers are sending electronic authorizations for which the doctors STILL has to take valuable time to fill out….sometimes over and over again.  The above comes from a fellow DPC doc.

“Yes, I actually submitted this for a prior auth, and it was approved. I wonder if anyone even read it?”

Exactly.

This madness needs to be stopped.

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  2 comments for “The Prior Authorization Scam

  1. John A Goldman, MD
    March 3, 2018 at 9:26 am

    You were absolutely right.
    do you want your physician focusing on science, reviewing the literature, trying to find the best therapy for the patient or do you want the physician to continue to do these Bureaucratic impositions, The prior approvals which is basically the insurance company trying to stop us from getting patient’s medications they need. This whole Farce continues, and no one has ability to stop this nonsense.

  2. Dr Irene
    February 25, 2018 at 10:16 pm

    Being a doctor in the US means a constant game of “how do we get the patient what they need?” And “how do I get paid waht I’m owed?” Insurance companies make the ever-changing rules and our job has been consumed by aiming at a moving target. Seriously- patients need doctors to be spending time on patient care. Not this ridiculous nonsense.

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