New Definition of "Runaround"
Last week I saw a young woman in her 20's, for whom I decided that treatment with oral contraceptives was the most appropriate medical option for her. So I wrote her a prescription. I did not specify on this prescription "Brand Medically Necessary" (the Pennsylvania version of "Dispense as Written") and so by law the pharmacist had the right to substitute a generic version of the medication. This was fine with me.
I got a call from the pharmacist saying that a preauthorization was required.
Ok; fine. That happens. But it took half an hour of my life I'll never get back to go through twelve telephone prompts, four messages to register my NPI, and three actual humans, just to have a form faxed over. I filled it out and faxed it back. In the meantime the young woman was told either that she'd have to pay $84.oo or $212.00 for it. (The story changed.) In any event, she's spending time in pain that I believe can be alleviated with the medical therapy I've prescribed, but that her insurance is not providing.
Today...(deep. breath.)...the response to the preauthorization...(slow. deep. breaths.)...came in over the fax:
Preauthorization not required; claim approved as generic.What. the. fuck! (dated last week, to boot!)
Please note that I am not accusing the pharmacist of being a moron. I fully believe that this particular insurance company routinely bounces back messages to the pharmacies that preauthorization is required when in fact it is not. Anything to hassle the patient and make it less likely that the company will actually have to end up paying for it.
You wouldn't like me when I'm angry.