Pharmstat Staffing

I’ve been noticing a trend at work recently. It seems like the already abundant prior authorization rejections I’m receiving when billing third parties for prescription claims is on the rise. What gives?

We all know that most of the prescriptions we fill at work on a day to day basis will be billed to some third party insurance processor. Rarely does the average pharmacy fill anything for cash except those drugs that are on one of the $4 lists that are so inexpensive it wouldn’t make a difference to file the claim under that patient’s insurance plan anyway. But it sure seems to me that we are being swamped with an increasingly frequent requirement of prior authorization from insurance companies before they are willing to cover a particular medication.

Sure this is just anecdotal evidence from work and yes prior authorizations are nothing new. But haven’t they drastically increased in frequency in recent months? What is the end game for this madness other than wasting a lot of time and effort on the part of the pharmacy and the doctor’s office in question just to get a claim to process?

I can’t help but complain a little because I think this entire billing process has spiraled out of control. What was once a fail safe for insurance companies to prevent doctors from needlessly writing for expensive alternatives to perfectly viable therapy choices that were lower in cost has now turned into some big game by the insurance industry. And in this game the patient loses!

Case in point was a recent store I worked at that had a stack of problems waiting for me one morning when I came in for an opening shift. But what that stack of problems turned out to be was a pile of prescriptions for controlled substances (CII class controlled medications) that were all waiting on prior authorizations to go through so the insurance companies in question would agree to pay for those medications. But what struck me was that in the entire stack I looked through not one was for a brand named medication. They were all generics!

To read entire article by The Redheaded Pharmacist, click here.