First thing this morning, I called pharmacy review for a health plan Re: One prescription written for the last 2 1/2 years for one of my patients, their "client". I called them last week to get permission to set up a time to talk to this person. Patient was without chronic drug for one or two days at risk of serious symptoms, often requiring emergency care to treat. "We don't cover that drug for the purpose of managing chronic pain."
That's interesting since my patient had no life potential on five other medications and now has a life on the drug you won't cover.
Me: Here's her story, "...".
"OK, the drug is approved, in light of that information, for six months."
" How about a year since her condition is chronic and stable if she takes that medication?
"No, we only approve it for six months."
"I'll pray for her to get a miracle, otherwise, I'll talk with you in five months"
"OK, but then you only have to send in the appeal form you initially sent us for the prior authorization, including the information you just told me."
"That information was on the form and told to your staff three times in the last five days by me and my staff."
"Yes, but now we understand what you meant (by speaking the words my writing suddenly had meaning for them)."
"In Canada, my patient would have been approved for life for the medication."
"Yes, but we're different"
Soon thereafter, I entered the room of my first patient of the day.
Knock, knock at the door, which I answer,"Dr Jonas, there's a pharmacist on the phone about the pain killers for ........ They want to clarify a few things."
"Here we go again," I think.
Ten minutes later I re-enter the first patient's room and apologize for the second interruption in our meeting.
A friend of mine had over 75 patients with the need for him to beg to continue the first drug mentioned above. He could call for about five patients at a time, even though he had a list with all their names and offered to submit the whole list.
Who will fix our broken, bankrupt system?