The pharmacy sent a fax to me, announcing that I had to call the patient’s insurance company to request prior authorization for the medication.
But… but… bupropion is generic, I thought. Why do I need to explain why I am prescribing a medication that costs cents?
I shrugged, resigned. One enters medical school and expects only to provide direct patient care: How shall I apply principles of physiology and pathology today? After graduation, one does provide direct patient care… and also fill out reams of paperwork and spend a lot of time on the telephone, arguing with bureaucrats.
These are the details that are not glamorized on television shows.
An automated voice greeted me after I called the 1-800 number and, after pressing “1″ to “initiate a prior authorization”, the telephone blared music that was meant to fill space, not pleasantly stimulate auditory neurons. I cradled the telephone between my head and shoulder. During the intervening five minutes, I scribbled ideas into my planner.
Suddenly, a woman began to speak: She told me her name. She did not ask for mine.
“What is the name of the patient? Date of birth? ID number? Group number?”
My urge was to sardonically comment, “Why do you care about all of these details when the medication is generic? It’s not like anyone will either make or lose money from this prescription…”
There are the things we say to assert that we are right. Then there are the things we don’t say so we are effective. I bit my tongue.
“What is the name of the medication?” she chirped.
“Bupropion,” I replied.
“Can you spell that for me?”
There are also the things we spell so we remain effective.
After asking me for the dose, she then said, “Thank you. I will now transfer you to a prior authorization specialist.”
Oh! And I thought that I had glimpsed the finish line.
More noise filled the phone. I spied a past copy of Newsweek on a nearby table and began to mindlessly flip through it. I began to read an article about the police officer who, as a decoy, arrested Senator Larry Craig for soliciting sex in the men’s restroom.
Seven minutes passed.
Another woman’s voice interrupted my reading.
“Hi, I’m a pharmacist in Las Vegas,” she said.
I suppressed my snarky urge to ask her about the weather in the desert.
“I will now proceed with the prior authorization inquiry,” she said.
Bupropion is GENERIC! I wanted to shout. You know this! Why are we doing this?
“Okay,” I said instead.
“Are you prescribing this medication for smoking cessation?” she clucked.
“No,” I answered, awaiting the next question.
“Alright. That is all,” she said.
What?
“The patient will receive an automated phone call to announce that the prescription is now authorized.”
Are you serious?
“We will also send a letter to the patient’s home address.”
I was on the phone for 15 minutes to answer one question about a generic medication?
“Thank you for calling,” she concluded.
“Thanks,” I automatically replied, incredulous. I hung up the phone.
Only the four walls of the room lent a sympathetic ear to my expressions of umbrage that followed.
22 Jan 2008 |
I am reminded of my dealings with Dell in getting computers repaired. I’d call up, full diagnosis ready to go, and spend phone tag bouncing around from technician to technician to order the one part I needed to fix the computer - five minutes to diagnose, fifteen minutes of hold music to the Backstreet Boys (yeah, seriously), a minute conversation with the L1 tech, thirty minutes of hold time once again to the Backstreet Boys, then the L2 tech who would get me my part. :-P
Comment by InThane | 22 Jan 2008 @ 10:32pm
Is this billable time - this idle time you spent waiting on the phone? Or does it not work like that in your part of the world?
Comment by rach | 23 Jan 2008 @ 12:24am
This is one example of why I will never do patient accounts/billing again. This is how I spent my day, every day, for 10 years.
Comment by Fallen Angels | 23 Jan 2008 @ 6:33am
Get ready for a lot of umbrage. This is the way it is. You’re lucky when you can talk to someone who actually knows anything other than reading from some prepared list of responses/criteria.
Much of this these days is handled with faxes, fortunately, but sometimes you have to read in between the lines to make sure you respond accurately and don’t create more trouble.
The main function of these systems is to be a barrier to care — that’s the bottom line of it all.
Comment by Greg P | 23 Jan 2008 @ 7:47am
http://www.theonion.com/content/video/in_the_know_is_the_government
the onion re: paranoid schizophrenics.
Comment by wealthandtaste | 23 Jan 2008 @ 8:21am
in their efforts to keep costs down (discourage care), i wonder how much they’ve spent in this situation? involving two different people? not to mention the hidden costs of sucking away a doctor’s time… ugh.
single payer!
Comment by Ali | 23 Jan 2008 @ 9:48am
I can relate to this situation that no doubt wastes thousands and thousands of hours in health care clinics in the US every year. When I prescribe an inexpensive tube of tretinoin (generic Retin A) for an acne patient, and even write “for acne” or “not for cosmetic use” on the prescription, I sometimes am still required to follow a similar telephone/fax song and dance routine that you followed for generic bupropion. Health savings accounts with the patient purchasing their own prescriptions, eliminating the profiteering middle man, is one of several solutions to this problem. Billing third party payers for the time it takes to get prior approval would also likely curtail this practice, though we know that will never happen.
Comment by Dan | 23 Jan 2008 @ 1:53pm
I think this is a form of job security for idiot process managers. I had to wait 10 minutes to get a fax number for a patient’s prescription…after verifying his name, social, DOB, address with TWO different individuals.
Comment by Rae | 23 Jan 2008 @ 9:59pm
What gripes my a** about this sort of thing is that it is perpetrated by that American sacred cow, private enterprise, which is supposed to provide ever higher quality and efficiency. Government brueaucracies take the public hit for this sort of thing every day (usually deservedly so, mind you), but private companies? Never. Oh, we complain–but the generic blast of public, widespread condemnation is reserved for government idiocies only.
Comment by Addofio | 26 Jan 2008 @ 7:39am
Pharmacies make money from generic medications. Far more money than they make on brand name meds. (If indeed they make any money at all from dispensing a patent-protected med.)
But you’re right. The absurdity of a PA for bupropion is off the charts.
Eventually the process will go online, I think. It’s cheaper than paying folks to answer the phone.
Comment by RJS | 27 Jan 2008 @ 10:55am
Imagine having to call the insurance companies ten, twenty times a day. That’s the life of a retail pharmacist. That’s why I got out of it and started in Clinical Pharmacy.
Comment by Chris, Pharm.D. | 29 Jan 2008 @ 7:56am