And the Bullsh$t Prior Authorizations Keep Coming

This was from another doctor who tried to prescribe generic lisinopril. The medication is less than $4 per month cash on goodrx.com, Walmart, etc. Some programs, like Kroger, it is free! And yet this patient’s insurance company is making the doctor do a prior authorization. WTF?!?

This needs to stop. I would not fill it. Patients need to be part of the solution. Pay cash. We need to push back.

Oh, and I hate COVERMYMEDS will a passion.

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] 

  11 comments for “And the Bullsh$t Prior Authorizations Keep Coming

  1. arf
    September 2, 2020 at 5:48 pm

    Just looking up GoodRx – dot – com prices,

    Lisinopril 10 mg #30, $4 to $5 most pharmacies, $13 at Walgreen

    Terbinafine 250 mg, #30, $9 to $11 most pharmacies, $72 at Walgreen

    I had a patient with toenail onychomycosis, put on terbinafine. Got a preauth request. At the time, terbinafine was on the Walmart $4 list, and other pharmacies had followed. I saw Walgreen on the preauth request, thought I’d check. The prescription that was $4 at Walmart and most other pharmacies at the time, was $60 at Walgreen.

    I don’t know, maybe it’s a stretch, I wonder if the preauths were intended to steer people away from Walgreen for their high prices.

    That particular prescription, I told the Walgreen that the prescriptions were a a tenth of their cost everywhere else, either match price or return prescription to customer.

    Patient told me the Walgreen pharmacist had nothing good to say about me. Patient told pharmacist the doctor was looking out for his patients, more than he could say about the pharmacy. Told the pharmacist it was time to find a new PHARMACY, not a new doctor, and left the pharmacist sputtering.

    I found it remarkable the patient said that, in that I had not told the patient the back story…….yet. Told the patient when patient told me of the experience at that pharmacy.

  2. arf
    September 2, 2020 at 5:22 pm

    Is it my imagination, or do these preauths usually come from Walgreen?

  3. Aaron Martin Levine
    August 26, 2020 at 5:10 pm

    I used to approach this in two ways. One was to send a bill to the requesting party saying that the form would be completed once payment was received. Of course I never got paid. The second is that I had the patient stay with me and listen on the speaker phone. One case for suboxone required an hour of the patient being with me, and it was still refused. The reason, alternative treatments for opiate dependency should be tried first. The patient said she would not have believed it if she had not been there.

  4. Gary Topper, MD
    August 24, 2020 at 6:58 pm

    My office advises all patients regarding this issue that due diligence on the part of the physician is completed prior to any Rx being issued. After the Rx is issued to the patient, if an authorization is required I advise that patient that it is their insurer creating the issue – not the physician, and not the pharmacy. I advise the patient that their insurer has a ‘primary’ responsibility to them as well an obligation (moral/ethical) to contact the doctor if they need ‘additional information’ for a so-called authorization – and not the other way around. I advise the patient that while I will complete a request for ‘additional information’ if needed, I will not initiate such a request – I require the insurer to send me a pre-completed request form (I do not accept any blank forms sent by an insurer) in order to properly identify the patient for whom the additional information is wanted . I also invite patients to make calls to their insurers (when time is available) requesting a 3 way conversation so that they can be involved in the discussion ) (I have the patient sign a release form). If the insurance company refuses, I advise the patient to report the refusal to the state insurance board. If the company representative, during a 3 way conversation, balks at having the patient on the line – I advise them that they are ‘primary’ to the patient, that the patient has approved being present at this conversation, and that I will recommend the reporting of refusal to continue to their state insurance board. While this has not stopped the insurance from using these ‘authorizations’ it gets the patients directly involved so they can directly see what it occurring and the time involved (most of my patients have been sympathetic to me and greatly angered by what they witness). Change absolutely needs to occur – but will only occur when there is a swell of people demanding it. Thus far – the complaint by physicians on this issue continues to fall on ‘deaf’ ears – therefore the complaint against the insurance company on this issue needs to arise from another source.

  5. Gary Pearce MD
    August 24, 2020 at 3:02 pm

    Usually they want to ascertain that you have not overlooked a cheaper alternative but $4 is probably as cheap as they come. The thing that really upsets me is when the patient starts calling the office because the pharmacy tells him that there is a delay due to the doctor not doing his job……then we look bad. It is impossible to explain this situation to the patient. And the government does not really care how bad we look.
    I am an ophthalmologist. I always add to any PA that patient risks blindness if the medication is not obtained as ordered and I tell the patient that. I also document everywhere that I have explained this liability to everyone. IT HELPS!

    • Stewart
      August 24, 2020 at 3:34 pm

      “And the government does not really care how bad we look”

      All PBMs and Medicare drug plans are private corporations.

      Can’t blame this on the government.

  6. Rusty Shackleford
    August 24, 2020 at 1:34 pm

    The collapse can’t come soon enough.

  7. Gabi
    August 24, 2020 at 11:04 am

    Sadly, this is what the insurers want, as it saves them money. Sure, for one person $4 is no big deal. However, for the insurer for a million patients it’s $4,000,000 in savings. They found another way to shift to the consumer what contractually they shoul pay for.

  8. Stewart
    August 24, 2020 at 9:58 am

    Name the insurer – they don’t deserve anonymity.

    • Douglas Farrago MD
      August 24, 2020 at 10:23 am

      Don’t know. This was sent to me

  9. Sir Lance-a-lot
    August 24, 2020 at 9:50 am

    I ignore all prior auth requests (Urgent Care), but my computer has been showing me pop-ups more and more often telling me that my prescriptions for cheap generic meds require prior auths.

    If the pt. hasn’t fled the building yet, I tell them the insurance won’t pay, but the cash price is probably cheaper than the copay. If it’s important, and the pt. has left, I call the pharmacy and tell them there will be no prior auth, and the pt. will pay cash.

    Of course, what is the long-term effect here? The insurance company is off the hook and doesn’t have to pay for the med.
    A well thought-out strategy.

    The Revolution is getting closer and closer.
    Drug and insurance company executives will be the first ones rounded up…

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