When Doctors Know The System

This blog started after prior authorization gone wrong and Today I have an example of when it went well. I recently did a podcast with the National Psoriasis Foundation and on that podcast we talked about how difficult it is to work with insurance and how much of a fight it is to get our medications. The doctor on that podcast said something to the effect of if you have the right doctor who knows the system you do not experience those challenges. When he said that I was thinking if only it was that easy. I have great doctors and they try and it is still a pain to get my medications. But what I have learned with my new neurologist is he was right. That doesn't mean my other doctors are not good at their job, it might mean that some medications are harder to get approved than others, but it does mean that knowing the system matters. My neurologist very transparently asks you for the information she needs to get you the medication you need. She does not skip protocols and still goes through step therapy but she knows how it works, has you try the failing medications for only as long you need to and documents with facts the information she needs to achieve the prior authorization efficiently. This week I got prescribed a specialty medication and the SAME day got the prior authorization approved. I should caveat that the medication was marked preferred by my insurance but still the SAME day! That never happens. I am so grateful to have a great doctor, who knows her stuff including the system. She is compassionate, intelligent and efficient. That being said, she shouldn't have to jump through hoops to get me my medications. Prior Authorization is a tactic to control costs for the insurance companies and needs to change.

To learn more about prior authorizations and what it is like for physicians to help us get the medications we need listen to this podcast episode from the American Medical Association. Politicians on both sides continue to fight for prior authorization reform to make this process easier for both physicians and patients EVERY time.