Prior authorization continues to delay patient care and treatment, impact outcomes, and drive up health care costs for all Hoosiers. Physician offices advocate for their patients but are forced to waste valuable time and resources on these burdens.
Your stories about how prior authorization impacts patients are a powerful way to help ISMA put
Patients Over Prior Auth.
Please participate in ISMA’s advocacy initiative by sending us the latest example(s) of payors inappropriately putting prior auth over patients. More than 110 stories have already been submitted to ISMA since the short intake form went live earlier this year.
There is no limit on the number of submissions you can make. In fact, the more examples we have, the more impactful it will be -- even if they are repetitive.
Kyle Littell, MD, shared, “I have been discharging patients from the hospital with a new diagnosis of COPD or uncontrolled COPD who need new inhalers at home. There are many types of inhalers, so we attempt to prescribe the ones that are being used in the hospital. They will typically require a PA due to the high cost of these medications. Several times, we have gone through the process of a PA only to have the insurance deny the medication and send a list of approved similar inhalers on the ‘formulary’ with the insurance. However, once submitted, the medications they recommended still require a PA to be completed, and on occasion the medication that is on the ‘approved’ list apparently is not ‘approved’ any more as the formulary changed sometime between when the fax was sent and when the PA was done. We then have to submit a third medication, also requiring a PA. We have been working diligently to try to identify these medications earlier than the patient's discharge date. For this process, we learned it could take several days, but if missed, it can delay the patient's discharge if they absolutely require these medications to prevent rehospitalization. Also, sometimes the insurance will send a note with the PA to look up the approved list of medications based on the patient's insurance plan. The generic website they send is not user-friendly and has so many insurance types that you aren't sure what you are even looking at.”
Visit
www.ismanet.org/PatientsOverPriorAuth to share your story and read several others.
Please consider sharing this article with your colleagues, even if
they’re not ISMA members. We want to hear from as many Hoosier physicians as
possible.
Thank you for continuing to advocate for the well-being of all Hoosiers. Your participation in this
Patients Over Prior Auth initiative will help bring about vital change.
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