Pre-Authorization?

It started with a prescription that I could not get a pre-authorization for. The pharmacy that I was with for over 30 years closed some stores and combined four into one. There was no choice. I received a letter informing me that all of my prescriptions had been transferred to a store much further away.

I had gone to the doctor, and they gave me a prescription for the medication, but I explained I knew I would need a pre-authorization. The doctor’s office assured me that when the pharmacy sent the pre-authorization form, they would fill it out and send it to the insurance company.

After the appointment, I called the pharmacy and requested the medication. I had valid refills that I had not used. The pharmacist said that he would send a pre-authorization request to the doctor’s office. A few days went by, and I had heard nothing, so I called the doctor’s office and they informed me they did not get the form from the pharmacy.

I went to the pharmacy because I had some other medication refills waiting and had an appointment for a covid booster. I showed up early because it was a new store to me. There was a crowd of people in the back where the pharmacy checkout was. I stood in the line so long that my legs were giving out. I was checking out the meds that were waiting for me, and I fell and banged my head. After that, I told the clerk that I was waiting for a booster, and sat in a chair in the waiting area. I quickly realized that there was only one man, filling prescriptions and running back and forth to the consulting area to answer questions. When I could get his attention, he said he would give me my booster, but I needed to wait.

When he finally took me and another woman in the back, he told me that since the closing of the other stores, his other co-workers were calling out and he was there by himself. I left there with his promise that he would send the form to my doctor’s office. That was on a Wednesday.

By Friday, they had sent no form to the doctor’s office. I called the corporate office of the pharmacy and told them of my experience; they promised me that someone in management would call me by the end of the day. No call came.

On Saturday, I transferred all my prescriptions to another chain. I told them I needed a pre-authorization sent to the doctor’s office. There were calls back and forth, and the new pharmacy confirmed that they received my prescriptions from the other one. I also received a call from the woman who said she was a manager of the first pharmacy. I told her everything that had happened.

I was bouncing back and forth on the phone between the pharmacy, the doctor’s office and the prescription plan administrators. The doctor’s office told me they did not get the form. Apparently, the doctor was mostly in the other office, so I had to ask the pharmacy to fax the form to the other location.

When I found out that the doctor’s office did have the form, they said that the tech would complete it and send it. A couple of days later, I was told that they were “just too busy”. I called every day or every other day. Twice I was told that the tech was working on the form, and would call me back. No call ever came.

Meanwhile, I got a letter in the mail from the prescription plan telling me they had denied my request because the doctor’s office failed to provide sufficient information. The prescription benefits folks told me that form they received was incomplete. Questions were not answered and it was not signed by the doctor.

I told the benefits plan people everything I knew. I did not know my diagnosis, but I told them why I was given the medicine. Interestingly, I found out that there was a generic. All this time, I had been paying big co-pays for the name brand. Something shifted. I guess it was when I said I was afraid to be without meds after such a long time on them and I did not care if it was a generic. The next day, I got a call from the pharmacy that the generic med was waiting for me.

Such a weight was lifted. I never take no for an answer.

The planner in me learned in real time businesses cannot run when they are under-staffed. The pharmacy who laid people off is a sinking ship. The remaining workers can’t handle the volume. They are voting with their feet.

Still to be determined is how I will behave when I go back to that doctor. Luckily, it isn’t for a few weeks. There is something wrong there. The techs are doing the majority of the work. There is not enough time for paperwork. The pre-authorizations need to be checked and signed by the doctor.

At a minimum, they shook my confidence in the doctor’s office. I could switch back to the other doctor in the practice. I have been with them for years. I feel over a barrel. I am afraid to switch.

Is this how everything will be in the post-covid world? My trust is shaken by my doctor and my pharmacy being too busy. I did not realize how much I trusted them until now. I am sad and worried about the future.