Prior Authorizations

[its2much]

How long does it take you to get a prescription filled that requires a prior authorization? I'm no fan of what the insurance companies put us through but it always takes weeks and several tries/phone calls, etc. for my doctor's office to do the paperwork. I've been on these medications for years but each and every year a prior authorization is required.

[JerryD]

My take away from your post is that you have a problem with all of the 'red tape' the insurer put in front of your need for medications. I have a similar problem with my insurer.
I guess it's the process that the industry has adopted as 'normal' !

[its2much]

Yes

I was complaining about insurance companies red tape; however, I'm also complaining/asking how long it takes your doctor to complete the "red tape", i.e. authorization, forms from the insurance company. It takes several phone calls and several weeks for my physician's office to complete them.

[Leah27]

The prior authorization process is really bad. As a patient, and pharmacist (in pharmacy and in a doctor's office) I have seen this from multiple sides.

There could be an administrative delay in your doctor's office, or the insurance company or both.

I have seen prior-auth renewals completed in as little as 3 minutes, and take as long as weeks depending on the doctor's office and insurance company.

If you know that your prior authorization expires every year, you can call your insurance company a month ahead of the expiration and ask them to fax a PA renewal to your doctors office and/or mail it to you. I then suggest you give the doctor's office a week to complete it and submit back it to the insurance company. Call the insurance company to check the status of the Prior Authorization.

[its2much]

Thanks for the Info/Suggestion!

I've been waiting close to 6 weeks now for the renewal to be approved. I usually receive a letter once I request a refill and the approval from last year has expired from the insurance company telling me the drug requires prior authorization. I haven't received one yet. Who gets this process started? Is it the pharmacy when I request a renewal/refill?

[Leah27]

Usually, if you request a refill and it requires a Prior Authorization the pharmacy will send a notification to the doctor and/or notify you of the Prior Auth required rejection.

It is then the doctor's office responsibility to complete the PA paperwork and submit it to the insurance company.

It is then the responsibility of the doctor's office to notify the pharmacy when they get the approval.

As you can see, there are lots of places the ball can be dropped along the way.

[its2much]

Thanks for the information

It's now two weeks later and still no approval - no notification other than the pharmacy telling me I need prior authorization. How does the doctor get the PA form? Why haven't I received anything from my insurance company telling me about the prior authorization as I have many times in the past?
Seems the doctor's office and the pharmacy aren't doing anything.....

[Leah27]

The doctor can get the PA form from the insurance company.

There are several steps you can take at this juncture.
The first step is to call your insurance company and ask the status of your Prior Authorization. See if you have been given a case #

If the doctor hasn't done the PA, you can get the PA paperwork from the insurance company and show up and sit in your doctor's waiting room until they complete it and then you can fax it yourself and ensure the insurance company gets it and you are given a case #.

You can also reach out to the drug manufacturer's support system and explain your trouble getting the medication- they can help you jump through all the hoops