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Wednesday, November 9, 2016

You Are Allowed

How about just saying what you really mean? "I am an asshole." Period. It is simpler that way and patients understand.
Wait. Allow me to back up a moment.

Twice this week, we faxed Dr. Zoffis prior authorization requests.
Twice this week, Dr. Zoffis replied with a fax that said: "patient is allowed to purchase this medication without insurance".
Well no shit, Dr. Obvious. The point of the prior authorization fax is to let you know the insurance won't cover the medication you prescribed, not to ask your permission for the patient to pay hundreds of dollars for it. They really don't need your approval to do that.

Here is the brief debate that ensued at my pharmacy:
CP: I don't like prescribers that do this. If you don't want to do prior authorizations, simply say that. but PLEASE make sure that your patients know you will not help them.
CPP: I don't have a problem with it. I see this as patients today walking in to the office and requesting to be placed on the medication they want.
CP: Okay. I will grant you that. Remember last week with the prescriber who refused to do the prior auth for a medication they prescribed after they had been giving samples to the patient?
CPP: Yes.
CP: The prescriber chose the medication. He gave the patient samples. Now that the patient's insurance won't pay, the prescriber tells him "too bad, so sad because I don't do prior auths"?
CPP: I see your point in this scenario.
CP: How is he servicing his patients if he won't be bothered to prescribe an alternate treatment? Just because he picked this particular medication, and it's not covered, he won't prescribe anything else?

It's one thing to have a policy against wasting time and resources on prior authorizations that may not improve patient outcomes or end up with you chasing your tail. It is quite another to offer the patient no other options for treatment. They came to you seeking help. You are their healthcare provider.

1 comment:

  1. As I told my patient today who wanted name brand benzo.
    'I will write it if you really want. It will probably be much more expensive than the generic and your insurance most likely will not cover it. I have no medical reason for you to be on name brand, so I will notdo any paperwork arguing that there is. Buy it or not or get the generic. Up to you.'

    ReplyDelete