Trying to understand prior auth's better.

[myoglobin, ASN, BSN, MSN]

So I just spent about 2 hours on a prior authorization for a client that has insurance with Cigna. This was the third time that I have had to get a prior authorization for this client and this medicine in the past four months. The person is being treated for ADHD combined presentation F90.2 and the medicine is Adderall XR 25mg (may substitute generic). I have titrated him up from an initial dose of 10mg and each time I have needed a separate prior authorization. I have other clients with Cigna who have not even needed any prior authorizations for this medicine. I have still others (with Cigna) where they needed a prior authorization, but it was good over a range from 10mg to 30mg.  I spend about 10 hours per day on my "off" non client contact days working on these and it is the hours on hold and endless transfers (and repeating ID numbers to automated systems that cannot understand my voice or even comprehend the key pad input) that makes me very frustrated. I have also tried "Covermymeds" but find that my clients get rejected at a much higher rate despite the fact that I answer the questions about previous treatments in an identical manner.  I am truly perplexed and want to understand this system better and how others manage more efficiently. 

[myoglobin, ASN, BSN, MSN]

Also, I just had another client where I called Express Scripts for a prior auth with Premera Blue Cross, and I was told that "of course I would have to get a new prior authorization" with every dosage change. However, 80% or more of the time I do not have to do so. I thought I was going to "lose it" and say something that I really regretted, because they acted as if this was always the case and  were perplexed that I was even asking the question. However, every month I usually do not have to do this on most of my clients (or I would do nothing else).  

[BSN2DNPFNP]

I am following this post for better insight to this topic.  Thank you for bringing it up.  There has to be a better/easier way about this.  

[DowntheRiver]

From my understanding, don't employers (or whoever is covering) pick and chose aspects of the plan which they may or may not cover? That's part of the reason why rates are higher than others. My husband and I both had BCBS PPOs at the same plan level but through different companies. The plans covered meds in separate manners and his plan covered one of my meds but my plan did not (I was doubly insured).

It's a nightmare navigating the system. I hate doing prior auths. In Oncology, we have to do them every month for the oral medications, even if the patient has been on it for YEARS. 

[myoglobin, ASN, BSN, MSN]

I spend almost as much time on prior auth’s as I do seeing patients. What makes me the most upset is that with many companies like Cigna I have to talk to an automated system that cannot understand what I say no matter how carefully I pronounce the clients ID number.

[BSN2DNPFNP]

There has to be a better, more time efficient way.  I'm curious do you have nurses/MAs/other office staff that work on this for you.  And how much time in a day do you feel is spent on this on average in your setting?

[myoglobin, ASN, BSN, MSN]

2 hours ago, BSN2DNPFNP said:

There has to be a better, more time efficient way.  I'm curious do you have nurses/MAs/other office staff that work on this for you.  And how much time in a day do you feel is spent on this on average in your setting?

I work IP and my support staff does not do this function. I spent about four to six hours on my "off days" working on this that is to say Sat, Sun and Wed.