Prior Authorization Frustration

February 13, 2018

A physician attempts to profess her gripes about the prior authorization process to a pharmacist to no avail.

I was at a dinner lecture the other night and somehow found myself across the table from a pharmacist who works for Boehringer Ingelheim. She was with one of their medical liaisons. I don't recall how we got on the topic of managed care, but at one point she asked a colleague and me how much time we spend on prior authorizations a day. I said an hour, sometimes two. Just that day, I had to do at least four and each one can take anywhere from 10 to 30 minutes, sometimes longer.
 
We complained (as I have in previous posts) about how ridiculous and redundant some of the questions are, about how unnecessary it is to repeatedly get authorization for drugs that had previously been approved, and how arbitrary the rules are. I told her all about an authorization for one of their drugs that had been denied that very day.

She stated that although she is relatively new to her current company, she has been working in her field for many years, and it was her opinion that managed care companies want physicians' feedback on the prior authorization process. I would have laughed at how ludicrous that statement was had I not been annoyed at how it represented yet again that the industry has no idea what it's like to practice medicine in today's healthcare system.

So I said to her, no, they do not. They don't want our feedback. They have nothing at all to gain by hearing us tell them that we object to them interfering with the physician-patient relationship. They will not profit from us telling them that patients should not be forced to change their medications annually as the formulary coverage changes. If they really wanted our feedback, there would be survey questions at the end of every prior authorization. There never is. 
 
She insisted that they (the managed care companies) do want our feedback, and that they (the pharmaceutical companies) can relay our concerns to the insurance companies. Oh, really? Prior authorizations are the direct result of collusion between the pharmaceutical industry and the insurance industry. So I highly doubt that the pharmaceutical companies want to be involved in this at all. 

So her brilliant (insert sarcastic tone) suggestion was that we call the medical liaison with specific examples every time we do a prior authorization that seems out of line. Really?  Are you serious?

So, after spending 15 minutes trying to get a prior authorization, you want me to take more time out of my day, more time from direct patient care to call the medical liaison and give him all the details of what transpired? She said they needed specific examples. Even the liaison who was with her knew she was wrong. He pointed out, that we just gave them specific examples (while maintaining patient privacy of course, no names were mentioned). She said that in order for them to go back to the managed care companies with our grievances, they needed examples.

So I asked her, "No one has ever talked you about these problems before?" It was a simple yes-or-no question. She refused to answer that question. I asked her three times, and each time, she evaded it. She had to. Because there is no question that she has heard these complaints before. I'm pretty sure it's why she asked the original question. Every poor untrained soul who has to answer the phone and ask the prior authorization questions has gotten an earful from a physician or his staff at one point or another. And so if those calls are "recorded for quality assurance", then you know that they know how unhappy we are. And there's no drug rep who hasn't heard the gripes. And how many blogs and physician surveys and articles do we need about physician frustration before they have enough "examples" of how displeased we are?

So, Miss industry pharmacist, I am not going to call your medical liaison with each and every PA problem. Just take this article back to the office with you. Oh, yeah, I forgot. They don't really care. I just do this for catharsis.

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