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Friday, November 3, 2017

Opioid Epidemic Hurts Everyone

In The War On Opioids That Amasses No Gains (WOO TANG for short) another innocent victim has been discovered. Companies are quick to promote themselves as leaders in the WOO TANG.
CVS Caremark announced how they are limiting supplies through the pharmacies.
States have limited quantities that may be prescribed.
Insurances are blocking anything more than a 7 days supply for a prior auth.
These are all great steps. 
However, as with all great strides, a few missteps must occur. 
Unfortunately, the innocent suffer. 

Uber-Tech: I need your brain.
CP: Trust me, you don't want it.
UT: I need its view of this.
CP: It will be skewed.
UT: Look at this reject for this child.
CP: "Max of 4/day". Got it. What are the directions?
UT: Take 4ml by mouth every 6 hours as needed for pain.
CP: Well, that is 4 doses per day. I'm confused why there is a limit. Let's call.
UT: On it.

CLueless Insurance Talker: How may I (not) help you today?
UT: What?
CLIT: Nothing. Go ahead and start getting phrustrated. This will not end well for you.
UT: I'm trying to figure out why this claim will not go through. I tried rounding up in case the insurance didn't like the days supply but I still get a reject.
CLIT: I see all of your valiant attempts. You probably haven't been this rejected since high school.
UT: What's the magic number I need to submit to get a paid claim?
CLIT: <drags out a long> Fooooouuuuurrrrrr.
UT: For what?
CLIT: Just 4. As in "per day".
UT: Speak English.
CLIT: The insurance allows a maximum of four(4) ml per day. Period.
UT: Units would've helped there. There is a big difference between 4 ml, 4 doses, and 4 days.
CLIT: Ahem. And now phor my prepared statement: "Due to new opioid limits, the insurance restricts this medication to a total of 4 ml per day. Should the patient require an amount to exceed the total of 4 ml per day, the patient must contact his/her insurance directly to begin the process of a prior authorisation."
UT: Wait. What?
<UT repeats phor CP>
CP: Wait. WTF? Dosing of 4 ml 4 times a day is normal. He does realise this is NOT an opioid, correct?
UT: You do realise this is not an opioid, oui?
CLIT: It is part of the insurance's ongoing battle against the evil scourge, the plague of opioid addiction blanketing communities across this great land of ours.
CP: It's phor a child.
UT: It's phor a child.
CLIT: We have to stop them early. Before they become addicted or these medications reach the hands of innocents for whom they were not intended.
CP: Can we request an override? Begin the prior auth ourselves?
CLIT: No. Only the patient can begin the process by calling her own insurance. They will then contact the prescriber for an override.
UT: This is rather complicated phor a little pediatric patient to deal with on a Phriday night at 5pm. By the time they would have completed the medication, the prior auth would not have started.
CLIT: Not my problem. These are the rules. Get used to them. I'm sure we insurance companies and PBMs will come up with even more mind numbingly phrustrating blocks to patient care under the guise of "helping" in the near phuture. <click>

UT: What now?
CP: Now that everyone is on the hook, let's tell them the medication.
UT: So they can get really pissed?
CP: So they can see the extent to which we went phor this poor little guy to get his prescription philled on his insurance. Never mind it cost less than $5.00. I just had to know why, no HOW the insurance blocked him phrom receiving his post-surgical pain medication under the "Opioid" banner.
UT: It really is ridiculous, nay ludicrous that we had to spend so much time to get an answer. It wasn't about getting reimbursed. It wasn't about the patient not being able to pay. It's the principle. This was the first time we had seen this rejection and it made absolutely no sense.
CP: Seriously. How in the world could an insurance company lump IBUPROFEN 100mg/5ml Suspension in with an Opioid rejection? It's not possible. It had to be an error. There had to be an override for a post-op prescription for a child. This is sold OTC. You don't need a prescription.
UT: We cashed it out, gave them a syringe, explained how their insurance sucked, and wished him a speedy recovery.
CP: Before you ask, this all happened well within the promised wait time, while we were accomplishing a multitude of other tasks so we didn't actually waste time on it. However, now you don't need to call on this rejection because we did it phor you.
UT: You're welcome.
CP: I hate insurances.

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