re: The Prior Authorization Process for Medicine

quote:

---

This is pretty much it.

And pharmacy is the middle man who gets the honor of often delivering the bad news that it isn’t approved . Once we send the fax, it’s out of our hands completely.

But even if it isn’t approved, you can still appeal the decision. That’s encouraged . That requires the Dr to fax more info to the insurance directly .

Good luck . And hope you didn’t need the meds right away bc PA’s take minimum a week to complete and that’s if everyone is doing what they’re supposed to do


EDit: some insurances will reach out and say hey Drug A for John smith was approved or denied. So we know to rerun the claim. But a lot of plans don’t, so after a week or so, recall the pharmacy to get them to rerun the claim for whatever drug it is

It’s shittey. I agree. I see it all day every day.

---

add in MTM, immunizations, the mandatory checking the PMP for every narcotic prescription, etc. and yeah, i don't miss pharmacy AT ALL!!!