Patients and doctors not the only ones hurt by prior authorizations

Apparently prior authorizations may not just be hurting physicians and denying physician-recommended treatment to their patients.

A blog posted by the Redheaded Pharmacist (a retail pharmacist who is redheaded) pointed out that prior authorizations are causing retail pharmacists to spend more time and do more paperwork for prior authorizations and that the PA’s were for generics (i.e., branded products are not the only “victims” of the prior authorization process):

I think this entire billing process has spiraled out of control.  What was once a fail safe for insurance companies to prevent doctors from needlessly writing for expensive alternatives to perfectly viable therapy choices that were lower in cost has now turned into some big game by the insurance industry.  And in this game the patient loses!

Case in point was a recent store I worked at that had a stack of problems waiting for me one morning when I came in for an opening shift.  But what that stack of problems turned out to be was a pile of prescriptions for controlled substances (CII class controlled medications) that were all waiting on prior authorizations to go through so the insurance companies in question would agree to pay for those medications.  But what struck me was that in the entire stack I looked through not one was for a brand named medication.  They were all generics!

It just seems to me that the insurance industry will advertise plans that say they “cover” all these prescription medications but when patients actually go to fill their prescriptions they are denied or must wait out the prior authorization delay before receiving their medication.  One insurance company had a form for both the pharmacy and prescriber to fill out simply for us to be able to fill for a generic narcotic pain medication for a cancer patient who obviously needed immediate pain relief.  Some patients just can’t wait for this new bureaucratic roadblock to be cleared before getting their medicine.

Of course, this blog is just one pharmacist’s observations, but does anyone have statistics, stories, studies, or comments about how prior authorizations are affecting pharmacists and about whether prior authorizations for generics are increasing?

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