exactly who is responsible for your prescription snafu?

I spoke with a patient today who blamed Andrew Cuomo because she was told by her mail order pharmacy that her prescription for tramadol couldn't be filled until someone from her doctor's office called the mail order pharmacy because the directions on the prescription were different from the one before. Really? How can someone go so completely off the sanity rails and land in this train yard?

One has to wonder if the conspiracy theorists are more abundant than previously suspected.

You've only taken the med for how long?

This one isn't so much about stupid shit patients say or do, as it is about the complete retardedness of certain aspects of the insurance industry.

Worked on a med prior auth for a med a patient has literally taken for fifty years, their CSR asks me if the patient has tried any formulary alternatives. My response: the records have been destroyed, and 50 years of documented med stability render your formulary completely irrelevant. Also, were any of the formulary alternatives even in existence 50 years ago? If they deny this claim, I will appeal to the surgeon general if need be. I am absolutely for reigning in the cost of health care, but we need to be realistic. Formularies are NOT one size fits all. You shouldn't force a patient to switch meds after FIFTY plus years because there's something your company pays less $ for.

So, after the company approves and renigs the initial approval, we appeal (the patient actually started the expedited appeal, YAY!), they approve on appeal and actually renig the approval based on appeal, citing need for more information.

WHAT

THE

F#CK?!?

This is the more polite version of what I wanted to send to the insurance company, the version the Doc approved.  I whited out several UPPERCASE complaint words, and deleted the entire line about the doctor not even being alive when this patient started therapy with the medication in question.

I've redacted the name of the insurance company/their prescription benefits manager to protect the guilty and also protect myself and my office from a lawsuit, which will surely ensue if the bad PR escapes to the general public.  I love that there are active plans in place to reign in the cost of health care.  I loathe the shit insurance companies get away with & without any fear of repercussion.

For the record, the company FINALLY agreed to pay for the medication.  They still haven't contacted me personally to advise me of this.  I found out via the pharmacy.