Prior Authorizations for meds

[stephiebob/lpn2rn]

I would like to know how some other offices handle prior authorizations for presciptions from insurance companies. I try to do all the work by faxing info (forms) instead of being on the phone so much. The problem is having to fax approx. 5 replies regarding the med or info on pts condition. Then in the end they want you to prescribe a different med or the original med is denied. It's very frustrating for me to have to go back & forth and in the mean time the patient can not get the med from the pharm. until it's approved.

[Saoudishabiba]

I do alot of prior authorizations for out physicians. I don't fax in my request, because it takes so long to get the reply. I phone in my request so that I am able to speak to a live representative and can provide all of the information needed over the telephone. Most of our prior auths are thru WV Medicaid. From my experience, most insurances that require a prior auth, will approve a particular med if the patient has met their criteria.

[J Lynn]

This is not a huge problem in our office. We don't accept Medicaid but sometimes the doctor will see a Medicaid patient as a favor to another doctor. We have to explain to the patient that we are unable to get approval on the meds prescribed and they may have to pay outright unless their PCP is willing to do it. On private insurances, I usually call the company, but just last Fri. I faxed a request and got it back within a few hours.

[greene]

Most of the docs where I work won't do prior auths, they will tell the pt they can switch to what is covered, or pay out of pocket. Doing prior auths wastes too much time.

[SalemRN]

At the clinic I work at we tend to check with the provider if they want to do a PA or change to a med that we know is covered. We serve uninsured and underinsured patients so we get a lot of PAs to consider. VERY frustrating for the provider, nurse and patient!!! Not to mention time consuming. We have to fax the majority of our requests. The turnaround time is very quick---usually within 24 hours. Yesterday afternoon I actually got one back that I had faxed over in the morning.

Just for an FYI, has anyone seen or used the needy meds web site?? Think the address is www.needymeds.com. It's a PAP web site and is easy to use. I was actually able to get a years worth of Advair for one patient and a years worth of Rosula cream for another patient recently. Always a good feeling!!! Doesn't work for everyone, obviously...