Posted tagged ‘prescriptions’

Navigating the pre-authorization nightmare

February 17, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

If the size of my stack of paperwork is any indication, 2014 will be the year of the pre-authorization. If you want coverage for a medication more expensive than aspirin, there’s a good chance it’s going to cost your doctors and their staff a mess of time and headache as they fight their way through flaming hoops of paperwork and phone trees.

Press 1 if you are a provider, press 2 if you elect to have red hot pokers jabbed into your eyeballs.

After a while, option 2 sounds better.

In a normal world, obtaining a prescription would work like this: you see your doctor, you share your concerns; a diagnosis is reached, and if a prescription is appropriate you discuss the pros/cons, the side effects, and anything else you need to know. Then you take your little piece of paper to the pharmacist, who gives you the pills. You pay your copay or whatever, and then continue with your life.

In 2014, there’s often an extra step. The pharmacist on her computer is told that a pre-auth is needed. Faxes fly between the pharmacist and doc, and we end up with multiple copies of a different form for every medication on earth, with all sorts of questions and little boxes to check off. Every drug has a different set of boxes, and — fun!! — we don’t know which boxes will get the drug covered. Even if we correctly get the boxes right, we’ll find out later that the medicine won’t be covered unless, say, the patient has already tried 2 drugs from group A and 1 drug from group Z (those come with an egg roll) for a minimum of 6 weeks, or 4 weeks in a leap year. And we have to send those records, and the egg roll, and a copy of the doctor’s organ donor card to the Lieutenant Governor (this is required to be sent by burro.) If the burro is late, we have to start over.

And, needless to say, half the time the insurance company will claim they didn’t get the fax. Or that the burro got lost. So we have to start over again. It’s like running a maze—except we’re blindfolded and don’t know where the walls are. And anytime the insurance company wants, they can send us back to the beginning at the crack of a whip.

Meanwhile: the patient waits. And fumes. And maybe says, “Forget it! I’ll just pay for the stupid medicine!”

Which means the insurance company wins.

Bonus for the insurance company: all of this makes the patient angry at the pharmacist and doctor, deflecting blame from their own oily “customer service” hides.

There are ways you can work together with your doctor and pharmacist to help fight this pre-auth nightmare:


Save big on prescription drugs… with no catch

January 27, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

Some things are too good to be true. But every once in a while, there’s a genuine gem out there—in this case a website that does what it promises to do, with no strings and no catch. It’s free, and it doesn’t collect or sell private information, and it really is just there to help you.

Needymeds was founded in 1997 by a physician who’s since become a good friend. His organization and website are there only to help people find ways to reduce the costs of their medications. It’s entirely non-profit, and unlike other “drug discount” programs isn’t there to skim off marketing information or scam you with hidden costs. There are no costs, and no private health info is collected. You’re free to donate (and please do!), but everyone can use all of the site’s features without spending a penny.

You will find great stuff at the Needymeds site:

One of their best features is a drug discount card you can print yourself, right there, at no cost. I know from feedback from my patients that this card really works. It can save you big time, especially on brand-name medications that may not be on your insurance formulary. You can use it whether or not you have insurance, whether or not you have a copay, or to save money if you haven’t reached a deductible. Print it out, use it for your whole family, suggest it to your friends. There are no fees, no registration, no income or residency or insurance requirements, no nothing. It’s accepted at just about every chain. You can download and print the card from this page, which also includes more info about how it works.

There’s also an extensive, easily searched database of drug discount programs—organized by both drug names and by diseases. You can also find diagnosis-based camps and retreats, listings of helpful government programs, information about finding discounts on MRI/CT scans, mediation for medical bills, and a zip-code based, searchable listing of discount clinics. Feeling overwhelmed with this details of signing up for one of the hundreds of  pharmaceutical discount programs? There’s a searchable database of free- or low-cost paperwork assistance organizations in just about every state.

There’s plenty more good stuff, too. Visit the site and look around. You will find legitimate, no-catch ways to save money. Prescription medications can be hugely and stupidly expensive—here’s your best way to fight back.