01/23/2024
How many patients have been frustrated when going to the pharmacy to pick up the medication you were prescribed and told by the pharmacist that they need to get your doctors approval for the prescription?
How many times have you called your doctors office asking for their golden stamp of approval in order to get the medication you were originally prescribed?
Let me answer these questions and provide a little bit of insight regarding this prior authorization matter.
A busy primary care office will spend about 80 to 120 full-time hours per week trying to get a patient’s insurance company to approve the medication written for them by their provider. This time is not reimbursed by anyone from the insurance company or the patient. When a provider sees, examines, and prescribes the most appropriate medication for a patient the insurance company begins to stand in between that relationship and refused to fill the medication written in the patient’s best interest.
Of course when the patient arrives at the pharmacy they are told that they need to contact their provider in order to get approval for this medication. What that really means is that the provider has to call the patients insurance company and go through a series of steps which could take hours on end to justify to the insurance company why the patient needs the medication.
You may ask why does the insurance company have any say on managing a patient’s health?
The insurance company approaches this in the manner that they know the majority of providers will not spend the time or effort trying to get a medication approved. Therefore the medication is denied and the patient is left to suffer the consequences of having their disease under treated.
All of the insurance companies have medical doctors who work for them in order to assist with denying appropriate prescriptions written for patients. They understand that by having a doctor employed this will allow for a large cost savings when denials are issued.
Patients can always request their insurance company provide them with access to these employed doctors and request an appointment with the doctor which will automatically be denied.
These doctors do not and will not ever treat a patient !!!
When confronted by the patient regarding how they can determine what is best for them opposed to the provider actually caring for them they do not have a leg to stand on.
As a patient you must be your best advocate and understand that your providers are also advocating for you but these are the barriers that insurance companies have constructed to try to make massive profits. Please understand that providers want to render the best medical care and we are being denied that ability solely for financial gain by the insurance companies. Not only does this occur in pharmaceuticals for the patient but also for testing procedures surgeries etc.
The impact pictured below is real and until insurance companies, lawmakers, and hospital organizations are held accountable nothing will change!! Patients will be cast to the curb and told to take generic medication‘s many of which do nothing or very little to help improve their health.
Also, physicians DO NOT get kickbacks from pharmaceutical companies for prescribing medication‘s. Just as innovation leads to new ways to do things, Medicine constantly evolves and allows for better treatments for patients. When physicians and providers know that changes in medication’s will help, they prescribe for these reasons.
