I Just Got a Prior Authorization Form to Fill Out on One Pill of Valium for a Patient

Yes, you read that right. I have to fill out a prior auth form for 1 pill of generic valium so a patient can get a breast MRI.

Cash cost with Goodrx. com is $1.25.

Our healthcare system is f%cked.

I just updated these with the prior auth. Pt’s name not on it. I had to actually prove I wasn’t lying. This was for ONE pill. One.

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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] 

  19 comments for “I Just Got a Prior Authorization Form to Fill Out on One Pill of Valium for a Patient

  1. Gary Pearce
    June 14, 2020 at 2:59 pm

    This is a continuous game played by the insurance companies whose objective is to delay and deny. Be it an emergency brain scan (for which I have sent patients to the ER and let the ER physician duplicate my exam un-necessarily but at least he has more clerks than I do, and of course the hospital is the one making the money for the scan rather than do this silly paperwork) or some change in glaucoma eyedrops (for which I simply write that by denying this refill you are assuming responsibility for this patient’s impending blindness. The insurance companies generally have nurses or pharmacists trying to steer you to their formulary medication which may in fact be the incorrect medicine but most of the time it is an essay exam where you have to document all diagnostic codes and give a history of every other medicine you have tried and what the effect was. IT IS STUPID! Yes, there are outliers who order a brain scan for every headache, and yes, there are docs who prescribe the newest med for every affliction. But these forms are a tremendous burden resulting in numerous phone calls to the office by the various parties involved. And once again the insurance company comes out looking pretty by telling the patient that they cannot have their medicine because the doctor’s office did not fill out the proper forms so patient hostility is directed toward us. The only way to stop this is with a uniform “Form Filing Fee”.

  2. Mamadoc
    June 11, 2020 at 10:29 pm

    Congratulations on retirement, Kurt. The end of a multi-year depression.

  3. stuart
    June 11, 2020 at 4:17 pm

    That they continue to send these indicates that yes, there are some docs who are stupid enough to fill them out.

    Of course, if you’ve got the time and the inclination, you can have some fun with these douche bags – send it back for 0.000168 pill ever 483 seconds, and other wrong information; get them on the phone and spend long periods of time heavy breathing; mail back requiring the medical director’s signature for delivery, etc.

    • Mamadoc
      June 11, 2020 at 10:26 pm

      Sounds like fun but you have far more time than I ever did.

  4. Jennifer Hollywood
    June 11, 2020 at 9:22 am

    I get these all the time. Preauths for very cheap generic drugs. Prescriptions where 90 pills cost under $20. I have no idea why the insurers are sending these preauths. I will tell the patient the goodrx price. And I inform the patient that I will NOT be doing a preauth.

  5. Dana
    June 11, 2020 at 6:02 am

    If the cost of the med is only $1.25 with GoodRx, I am calling BS on this particular blog. Umm, if the patient wouldn’t pay $1.25 to Have themselves relaxed for a test, then their is other issues at play here versus just the fact that an authorization was required.

    • Douglas Farrago MD
      June 11, 2020 at 6:43 am

      The patient did pay that. I am just calling out the insurer for trying to make me fill out a prior authorization for it. Do you need a screen shot to make you feel better?

      3
      1
      • Dana
        June 11, 2020 at 7:32 am

        Nope, just an honest blog instead of one that purposefully is intent on misleading folks.

        • Rick
          June 11, 2020 at 8:29 am

          Dana, holy cow, do you even read this blog?? I have, for a long time. No one, NO ONE ,has EVER intended to mislead ANYONE.
          If anything, the columns are pieces of brutal honesty and frankness.
          Oh wait, you must be a nurse!

        • Douglas Farrago MD
          June 11, 2020 at 10:30 am

          I just put the form (one of the 8 pages) on above. Don’t ever call me a liar again.

  6. stuart
    June 10, 2020 at 12:50 pm

    “Our healthcare system is f%cked.”

    As long as physicians refuse to say “No,” and voluntarily go along with what ever insane demands the insurers and PBMs make – yes, we’re f**ked.

  7. Diane Bergmann
    June 10, 2020 at 12:00 pm

    Absolutely. And not fixable. We need to tear it down and start over.

  8. Rick
    June 10, 2020 at 11:35 am

    You know, Doug, this just happened to me too. First time. My reaction? WTF?!
    So, my Rx was 2 tablets of Halcion. And for that, I faxed and filled out for several minutes. Good use of time.

    The bureaucrats have a vise-like grip on us. And it is getting worse.

    • Rusty Shackleford
      June 10, 2020 at 1:24 pm

      Why wouldn’t the patient just pay for it?

      • stuart
        June 10, 2020 at 2:11 pm

        Why wouldn’t the physician tell the patient to just pay for it?

        This is where a straight payment system, as used by lawyers, accountants and every other profession on the planet, is superior even to DPC.

        “Yes, I’ll be glad to complete that pre-auth for your two Halcions. As soon as you pay the $100 fee, I’ll send it in.”

        • Douglas Farrago MD
          June 10, 2020 at 2:39 pm

          The patient was told to pay cash for it. Just making a point how ridiculous things are getting

          • Dana
            June 11, 2020 at 10:58 am

            Nice try Mr. delicate nature, read your original blog post again.

          • Douglas Farrago MD
            June 11, 2020 at 12:28 pm

            You’re right. I am sorry you are an idiot

          • Kurt
            June 11, 2020 at 12:14 pm

            True, for cheap generics I refuse to fill out prior auths period. I’ll look up coupons but I will not waste my time even though in 19 days I will be retired and a civilian. Will not maintain the license because it would cost too much time and money.

Comments are closed.