prior authorization

[rsinger]

Just wondering how long it takes before prior authorization goes through. Almost 2 weeks since my neurologist faxed prescription to caremark. Still waiting for prior authorization. Where does it get held up? Caremark says that the doctor's office has not completed the paper work for prior authorization. I am confused.

[Justsayyes]

Just went thru this myself. Call your neuro's office and tell them Caremark has not received prior authorization.
It is paperwork the doctor's office provides.

[onlyairfare]

Those Prior Auth (PA) forms can be very tedious for your doctor to complete, and there are many places they can fall between the cracks along the way.

Sometimes the PA form must be reviewed by an insurance company committee, maybe one meeting only once a month - another delay. The insurer may have "lost" the PA - possibly really lost in the blizzard of paperwork, perhaps deliberately placed in a stack of papers that will be ignored for months.

For the OP, rsinger, maybe you should call and ask the doctor's office if they are sure they have completed your form and faxed it, since Caremark says they don't have it. Maybe someone in the office made a mistake or maybe they should re-fax it because the insurer or Caremark made a mistake. It seems to me two weeks should be plenty of time. I have had my prior auths turned around in as little as 5 days! I've also had much lengthier approval processes. And I once had insurance that didn't require PA at all - I just took my rx to the local drug store to have it filled.

There is only one real reason this PA process is done: to save the insurance company money by avoiding payment for an expensive drug; many patients give up at this point and never get the med. The insurer will claim "It is for patient safety and to ensure the patient gets the best care." Baloney!

This topic makes me very angry. MS is bad enough, we don't need these extra hassles. I hope you get your prescription filled soon.

[Justsayyes]

Prior authorization

Provides is not the right word. It is paperwork the doctor has to complete for the insurance company or pharmacy. I am not sure which, at the end of a flare and tired!

[AriD]

I've gone through this waiting as well. With my old doctor my meds went throughout quickly. The new one ( required to change with insurance changes) it has taken over a month. Back and forth between Caremark and doctors office saying not done or done. Real rigmarole. I'd call your doctors office to see if they can help out at all. Good luck!

[Justsayyes]

It still took me two weeks to get my medication after a valid prescription and prior authorization was in place. There was nothing I could do to speed the process. I was off my medication for six weeks, and haven't been the same since. Flaring and flaring over and over. It's a crime when a pharmacy is so large with such a cumbersome system that it prevents patients from getting medication on a timely basis. Physician offices have better things to do than spend so much time on paperwork. End of rant.

[Diamond57]

Me too!

r singer I am going through exactly what you are dealing with and it's driving me nuts!!!!!! 5 weeks ago my neuro told me I'd be starting on my treatment rebif and the insurance company denied it it because to my understanding the paperwork wasn't filled out properly from the Doc. Now there's an appeal going on. I feel like they're playing with my emotions. I guess I just want to get started. It's stressful. Thank god I have ativan to calm my nerves. I was diagnosed June 28th but have been sick on and off for years with fibromyalgia and numerous other heath issues. I'll keep an eye on this thread to see if anything new arises for you. Best of luck as we both need it right now. I try to keep busy. Walking helps my stress and I just bought a recumbent bike on Craigs list. I want to do everything I can to help my self. But it's my nervers that gets the best of me.

Have a good weekend and hope to hear from you. Are you feeling like I am????
Susie Q