Ridiculous Pharmacy Problems That Cause Doctor and Staff Burnout…and Try to Kill Our Patients
Last week, we started getting the same notification for a lot of our patients: “Levothyroxine is not on your patient’s formulary and needs prior authorization.
In case you didn’t see my cartoon on prior authorizations, here is the link:
HEALTH INSURANCE PRIOR AUTHORIZATION
https://youtu.be/xNJ3mxDzEhs
The notice came in several different formats. Like many busy practices, we have a lot of patients on levothyroxine. It is one of those drugs considered “essential to stay alive” if you have hypothyroidism. The burden of prior authorization work for our staff suddenly became even more unbearable.
Then, it got even worse. As we used the “Cover My Meds” Web tool for prior authorization, navigating a long list of obscure questions, the answer was always the same: “Prior authorization is not needed for Levothyroxine.”
Except… Apparently, it was needed if patients actually needed the medication. Now what?
Knowing it is a cheap drug, we told patients: “Use GoodRx and you’ll spend only $10 to $15 for 90 days.”
As a side note, patients noted they had been paying $50 at CVS when it had been “covered” by their insurance plan.
But the question remains: Why is such a basic and essential drug being held out as “non-formulary” requiring doctor acrobatics for approval that was apparently not needed, except they still couldn’t get the prescription filled. Can we all agree that a hypothyroid patient stopping their levothyroxine is a really bad idea? But, every time we made the attempt, we learned prior authorization was not needed. But, the denials from multiple pharmacies, both mail order and local, continued. The prior authorization requests piled up and the denials multiplied. We started screaming: “What insanity is this?!?”
How many elderly patients simply gave up and went without their thyroid medicine?
This week, one of the requests looked different from the others and is reproduced above. This particular request held the clue to this crazy, pound-your-head-on-the-table problem.
So… Stop reading this, look at the image above and see if you can find the answer.
Here’s the solution to the puzzle:
With the new year, a lot of our patients had their drug coverage switch from Express Scripts to OptumRx. Express Scripts “helpfully” transferred the prescriptions to OptumRx. Unfortunately, everyone on levothyroxine tablets, which is the only form of levothyroxine I’ve ever seen, had the new script transferred as “LEVOTHYROXINE CAPSULES.” I had no idea such a thing even existed. Apparently, for all intents and purposes, it does not exist. By law, Pharmacies are not allowed to make this switch without specific physician authorization. Violating that law, however, the Pharmacy Benefits Managers Express Scripts and OptumRx made that change.
So, Express Scripts sends over the wrong information. OptumRx dutifully records the wrong information or changes it themselves. No human pharmacist is in the chain to ask the important question: “Capsules? Huh? Is that what was really ordered by the doctor? ” The prior authorizations requests never mention the word “capsule” until the letter above arrived.
The solution: Reorder the levothyroxine as a TABLET.
Instead, the pharmacy plans force us to play the children’s game “I Have a Secret” as we try to guess why it is not working. Just try to get a human in these places to investigate the issue.
So, doctors, nurses and their staff all bang their heads on a wall, trying to guess “the secret” so their patients don’t die from myxedema coma.
Shame on you Express Scripts! Shame on you OptumRx! Shame on you United Healthcare!
Issues like this will continue in the future. I have seen insurance companies change their names or their addresses for no apparent reason other than to complicate the reimbursal process. Or they can even issue new policies with new codes AND THE PATIENTS TYPICALLY SAY TO THE RECEPTIONIST THAT ALL THEIR INSURANCE INFO IS THE SAME…..can you wait to retire?
“Shame on you Express Scripts! Shame on you OptumRx! Shame on you United Healthcare!”
Shame on the medical societies that claim to represent us, and that have rolled over and played dead in reaction to this abuse.