Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Monday, June 23, 2008

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.

But no.

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.

I'm angry.

You wouldn't like me when I'm angry.


At Mon Jun 23, 09:41:00 PM, Anonymous Anonymous said...

At first when i saw the "you wouldn't like me when i'm angry" link, I thought it was going to be a link to your Pharmacy rant. You're already big and green (I assume that all dinosaurs are big and green), so you'd turn into a rambunctious ranter when you're angry.

At Mon Jun 23, 11:18:00 PM, Anonymous Anonymous said...

F'n weird. There's a piece of the puzzle missing somewhere.

What medication was it? Many OCPs have generics that have tradenames, and it could be that a particular tradename generic (that that pharmacy doesn't stock) is preferred.

For instance Estrostep = Tri-Legest = Tilia. That's the only thing I can think of.

Very bizarre.

At Mon Jun 23, 11:57:00 PM, Blogger Andy said...

Forgive me for asking (since no else seems has yet), but... what the HELL was wrong with this young woman who is in pain that she couldn't pay eighty-four damn dollars? WTF??? Eighty-four dollars is a small price to pay to alleviate pain, if it is truly severe.Eighty-four dollars will purchase several packs of cigaretes. It will also purchase about 6 or 7 cases of beer, depending on the type. Not quite enought to purchase one of those costly designer bags, but... almost enough to purchase one of the knock-offs she brought with her to your office. Or was this woman a whiny, self-serving yuppie who felt that she should pay no more than her customary 5.00 co-pay?
Just asking.
Pharmacist-slash-medical student (with the understanding bedside manner).

At Tue Jun 24, 12:31:00 AM, Anonymous Anonymous said...

I dunno, andy. $84 is a decent chunk of change, especially when you've already paid quite a bit more than that (I presume) for insurance you were told would cover your medication. Nice of you to presume that she's spending all of that money on smokes, beer, and handbags. For contrast, that money would cover my phone AND my water bill. It would be hard to part with that money not knowing that I'd get reimbursed (since not all p.a.'s are approved, as I'm sure you know).

I'm with rjs, by the way, that something's missing somewhere. And that it's most likely the insurance company's fault. A patient brought in a paper tonight saying the pharmacist should call the insurance to have an old claim reversed then re-ran, just by calling an 800 number. They told me when I called that they couldn't help me. Yeah, that's 20 minutes I'll never get back either.

At Tue Jun 24, 09:28:00 AM, Blogger jen said...

WTF??? Eighty-four dollars is a small price to pay to alleviate pain, if it is truly severe.

$84 a month? (Or $212 for 3 months, if that's what the two prices were about.)
With the cost of gas and food going up? And given the age, she may either still be in school or just out of school . . . .

At Tue Jun 24, 10:08:00 AM, Blogger Bardiac said...

So was this just a regular run around, or was this someone deciding to make her life difficult because she wants birth control?

At Tue Jun 24, 11:03:00 AM, Blogger Lynn Price said...

Birth control is used for a lot more things than preventing babies. Dino eludes to this by saying the patient was in pain.

Secondly, why should the patient have to shell out 84 bucks when she has insurance? That's plain idiotic. That her HMO is making Dino's and the patients life impossible is standard operating procedure. Those bastards do this for kicks. Who gives a shit about actually providing timely health care/medications when you can wear them down by attrition? And this is exactly what national health care will look like - only worse.

At Tue Jun 24, 02:17:00 PM, Blogger Doc said...

Spot on, Lynn. The insurance companies will just shrug and then use the government as an excuse, and good luck making that phone call.
I get this garbage all the time, as a large percentage of psych. meds require PA. The generic substitution accepted after a PA was requested has happened to me twice in the past month..Once for Ambien/Zolpidem, and once for Zoloft/Sertraline. I cannot figure out why, though and am hoping it's just a coincidence.

At Wed Jun 25, 08:52:00 PM, Blogger Mother Jones RN said...

84 bucks is NOT chump change. Why should the patient have to shell out that kind of money when she has insurance? Lynn is right, insurance companies are slimy SOBs.


At Tue Jul 01, 05:15:00 PM, Blogger Andy said...

Ahhhh... You are all so free with your opinions. But what does the dinosaur think? Was it worth his time? Was she smoking profusely or carrying a fendi bag?


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