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Monday, April 12, 2021

Prior Auths In Two Parts

A: The Self-Fulfilling Prophecy
CP: In prison, I learned that everything in this world, including prescriptions, operates not on reality. . . 
CPP: . . . but the perception of reality. 
CP: Posit. New insurance requires prior auth. Previous one did not. 
CPP: Consequence. Patient is mad and blames you. . .
CP: . . . Not understanding the process itself or her insurance. 
CPP: We fax/call her provider for the prior auth for her medication. 
CP: Result: Patient goes to another pharmacy only to discover. . . 
CPP: . . . They don't require a prior auth because we already took care of it. 
CP: Thereby making us look like the inept fools. 
CPP: Conclusion: The patient believes the failure of the system is caused by our pharmacy. 
CP: Precisely. 

B: Motivation
CPP: How do you get a prior auth? 
CP: The most efficient way?
CPP: Natch. 
CP: Step one. Tell the patient her new insurance requires a prior auth. 
Step Two. Make sure the Rx is for a pain medication. 
Step Three. Wait. 
Step Four. Field the phone calls from the patient, the provider, and the insurance over the next hour until prior auth goes through. 
Step Five. Celebrate having to do practically nothing while the motivated patient did all the work for you. 
CPP: Awesome. I mean it IS her prescription after all. It should work this way all the time.
CP: Witnessed it myself last week. Amazing sight. 
CPP: We should coordinate a "buddy system" for prior auths. 
CP: Like Big Brother Big Sister?
CPP: Yes. Partner a seasoned professional prior auth go-getter as described above with a neophyte, "that's-your-job" slacker. The slacker gets her prior auth and the pain med patient gets her copay covered. 
CP: Terms to be decided/negotiated as the deal is struck, specific to each pairing.
CPP: Never underestimate a motivated patient. 
CP: I just wish it weren't this difficult. Whether for a procedure or a medication, it really shouldn't be this difficult. 
CPP: People need to understand we can only do so much from the pharmacy and the providers' offices. 
CP: THEIR lives and the fate of THEIR prescriptions are in THEIR hands. 


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