Prior Authorizations
All doctors hate prior authorizations. Why? Because we ALL know that it is only based on saving insurers money. As their profits go up and their stocks increase, we physicians sit on the f%cking phone only to fight with an idiot on the other end. Or, better yet, we get an electronic prior authorization to be filled out via a portal. You spend a ton of time filling it out and it doesn’t matter because it gets rejected anyway. And then it’s back to waiting on the phone again. I really believe they just trying to piss us off for fun. Once again, we are treated as clerks and are put between the patient and the insurer. They are even doing this with generic meds now. God, I hate these insurance companies and PBMs.
Anyway, this just came out:
Building on data released earlier in 2019, which showed near-universal dissatisfaction with PA protocols, the AMA is again urging health plans to reduce the administrative burdens associated with the pre-approval process.
“While health plans and benefit managers contend that PA programs are important to control costs, providers often find these programs to be burdensome and barriers to the delivery of necessary patient care,” the professional organization wrote.
Here is my question. What do you think the health plans and benefit managers will do whey then see the AMA urging them to do something?
- Laugh until coffee comes out their noses
- Reply with a collective “Who gives a sh*t what the AMA wants?”
- Respond by giving their executives a higher bonus.
- Nothing. They listen to no one. They care about no one. It is their ball and their playground and until someone does something it about then it is their rules and screw everyone else.
- All of the above
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A big damnable item is someone is on a “higher priced” statin for years ’cause they can’t tolerate the cheaper stuff. Insurer mines their data and says to you they’re not going to pay for it anymore and ya gotta use the generic. You can substitute any drug you want here and it drives me crazy.
Even though you tried the generic it doesn’t work and the Docs keep getting harassed. I say God “condemn to Hades” anyone who dupes a medical student to go into primary care in its current state.
Amen.
Prior authorizations are making practice impossible. It doesn’t matter: Regular insurance participating docs, DPC, Concierge Care, Cash only care…. We are all getting killed by this. You either do it yourself or you pay someone to do it. It is destroying our ability to take care of patients.
Yet, I also blame the pharmaceutical companies. The prices on these drugs are totally out of control.
I’m seeing lots of Trelegy inhaler advertisements as I watch the Basketball tournaments. The price is covered up when the reps come to the office: “One year of deductible waiver! What a deal! Cheaper because you only prescribe one inhaler for all three modes of therapy!”
Yet, GoodRx says the cash price is $557 for 28 days. Somebody is paying for that. Of course insurance doesn’t want to cover it! It’s cheaper for you to die!
Then, you have other issues: Lying insurance companies. If someone receives a prescription for 9 pills of Generic Maxalt, the insurance will claim they paid their own mail order pharmacy $300. Yet, the GoodRx price is less than $15 for cash pay. So, the insurance is lying about the burden of the medicine.
It feels like the doctor and the patient are in a giant house of mirrors trying to figure out how to navigate care!