"prior authorization" dream

"What do you mean my prescription is not covered?!?!?", woman screaming at the register.

"Your insurance doesn't cover this medication without a prior authorization, that means your doctor has to call insurance and explain to them why you have to be on this medication......"

She's getting more angry, "What do you mean my doctor has to call? He wrote the prescription that means I need it!"

We try to stay calm and explain patiently, "It usually happens when doctors write for expensive medication, especially if there's something similar, such as drugs from the same family, which is available in generic or over-the-counter."

"I don't care. I pay for my insurance they should cover everything!"

"We've already contacted your doctor but it takes time for them to call and the insurance will need to review the information before they decide to approve it or not." What else can we do?

"I need my medication. What am I supposed to do?"

* * *

Prior authorizations are big headaches for pharmacies. It's time consuming, frustrating, annoying. On one hand, I understand it's an attempt to cut the outrages drug costs. But on the other hand, it's no fun to call the doctor (we've more than 10 PA's to call everyday), explain to the patient, follow-up with insurance (sometimes), call the doctor again.....

?

My ideal scenario: When a patient receive a prescription at the doctor's office, there is an education pamphlet along with it explaining the possibility of requirement of a prior authorization and what will be done. Insurance companies can create websites with formularies, forms, instructions for doctors/pharmacists/patients, status update, and immediate help from representatives. Pharmacists and patients can check if the insurance has received the necessary information, if they're being reviewed, and if authorization was granted. When a medication is approved, the pharmacy and patient should be notified by email or fax. No confusion, no argument, everyone is happy.