Pre-authorization is hell. Here’s why: Kevinmd.com

Filed Under: Costs, Health plans, Patients

“This April, my turn to take the medical board exam rolled back around, necessary every ten years for maintenance of certification. I studied diligently for the better part of three months … It was actually pleasurable to go back over details that I had forgotten and to catch up on newer developments in the field. I realized that I don’t do nearly as much studying, or reading the medical literature as I once did. I used to read an article or two and browse the general medical literature for updates on a daily basis,” Matthew Hahn writes over at Kevinmd.com. “But my priorities have changed over the last few years. Now, instead my staff and I spend our time fighting through the incredible sea of silly red tape necessary to get paid and to get our patients even basic care. Here are the highlights from just this last week: Friday night, I got a message from a type 1 diabetic patient that he was running out of his Lantus insulin. He has been on Lantus for years, and of course, needs it to survive. I spoke to my nurse, who informed me that the prescription was held up in prior authorization. The patient’s insurance recently informed him that Lantus was no longer a preferred medication on his formulary. Apparently, despite using this vital treatment successfully for many years, we now need to make the case that he has failed with Lantus to justify approval of Levemir insulin, which is now the approved insulin. We’ve learned not to obsess about things like the fact that he hasn’t failed Lantus. This is just what we have to do to keep patients like this alive in the current bizarre system. Speaking of prior authorization, we have now been informed that we need to get prior authorization to prescribe a muscle relaxer for any patient over the age of 65. Muscle relaxers are apparently so dangerous, and my judgment as a physician so faulty, that the prior authorizers need to get involved. I guess I’ll just have to write more prescriptions for Percocet now because I don’t have time for all these prior authorizations.” Matthew Hahn, “Pre-authorization is hell. Here’s why,” Kevinmd.com.