Get insurance, lose medication coverage

One of the nice things about working in a clinic that caters to the underserved population is that the insurance-generated busy work is greatly reduced.  Certainly other challenges exist, but the busy work is nothing compared to dealing with the better-insured population.

Except for this morning.  Apparently one of my previously uninsured patients managed to acquire insurance and, in apparent celebration of the event, her insurance company faxed me a notice that one of her medications required prior authorization.  The cheery announcement was on my desk to greet me as I hung up my coat.

Prior authorizations are perhaps one of the biggest time sucks in the office of a primary care physician, and more often than not serve to benefit the insurer more than they do the patient.  Yet if I don’t do them, my patient has to pay for his or her medication out of pocket, or worse, go without.  So I poured myself a big cup of coffee, reluctantly picked up the receiver and dialed the 1-800 number.

Not surprisingly, I was immediately placed into automated-voice-menu hell.  I am a provider, so I pressed 2.  Yes, I wanted to access the prior authorization menu, and pressed 3.  Still a provider, pressed 2 again.  No, I didn’t want to sign up for a provider number and password, said “no”.  Entered the patient’s ID number.  Over-enunciated the name of the medication three times before the voice-recognition software correctly guessed what I was saying.  Then, after eight and a half minutes of this nonsense, was placed on hold for the next available agent.

While waiting, the recording informed me that I could initiate the prior authorization process online.  Excited, I found the company’s web page, only to discover that to access the prior authorization pathway, I need to enter my provider number and password.  If I wanted to sign up for one, I needed to call a different 1-800 number.

Another five and a half minutes passed.  Finally, my call was picked up by someone who could have been Barry White’s lesser-known brother.  Our conversation lasted about thirty seconds, at the end of which he informed me in his sultry bass voice that the medication in question simply wouldn’t be covered.  I asked if he could suggest any alternatives that were covered by my patient’s insurance.  He named three, but cautioned that they might require prior authorization, also.  Can’t get enough of that love.

In the end, I spent about fifteen minutes on the phone, more than the average amount of time that a physician spends face-to-face with his or her patient, and my patient still can’t get the medication that has served her well for over four years.  At least when she was uninsured she qualified for the pharmaceutical company’s drug assistance program.  And sadly, although I haven’t read the latest rendition of the health care reform proposal, I don’t recall hearing that issues like this are being addressed.