Comments on: Does a doctor have to pre-authorize prescriptions with the insurance company?

By: texjeff111

texjeff111 — Sun, 23 Nov 2008 06:30:01 +0000

First of all I want to correct some answers given. Doctors call insurance companies all the time to get what are called prior authorizations done for certain medications to be covered on patients insurance plans. The problem is that this process can take several days in which the patient is without medication. Secondly it is not the job of the pharmacy to find out what medication is covered by someone’s insurance. The doctor is provided a list of covered medications and they just won’t take time to look them up. The patient can call the toll-free number on their insurance card and ask them what medication is covered in certain classes such as ulcer medication, etc. Then let the doctor know what should be prescribed. Everything is not the responsibility of the pharmacy. The patient can do a little work to save themselves hundreds of dollars on some of their own prescriptions that are not covered.

By: aaron p

aaron p — Fri, 21 Nov 2008 19:30:50 +0000

Very few doctors do this. Try asking the pharmacist about alternatives that your insurance does cover. That’s their job. If the pharmacist has any question, they will call your doctor to make sure the switch is okay.

By: bob s

bob s — Wed, 19 Nov 2008 18:27:07 +0000

some doctors will take the time to be aware of what meds are ‘covered’ under insurance and which are not

your doctor really does not seem to care, but I bet if you go back to the doctor’s office they will be able to change the prescription to one that is covered

an alternative that i have done is order some meds in generic form from the online pharmacy site below, quite often these generics are cheaper than the insurance copays

bottom line, either push your current doctor to give you a perscription that is OK with your insurance company or find another doctor

By: sls314

sls314 — Mon, 17 Nov 2008 12:42:40 +0000

Generally the only time a prescription needs prior authorization with the pharmacy is when it is a brand-name medication.

If there is a generic equivalent that you can take, it should bypass this problem. Or, check to see if there are other alternate brand name drugs you could take – sometimes its one specific brand name that triggers an authorization (perhaps its not on your formulary, etc.), while another brand name might not trigger an auth request.

By: zippythejessi

zippythejessi — Sat, 15 Nov 2008 05:06:29 +0000

What do you mean by “pre-authorize” prescriptions? Unless you’re getting a brand-new medication, one that’s being prescribed for something other than it’s intended use (like a diabetes drug for weight loss purposes) or one that’s REALLY absurdly expensive (hundreds of dollars a month), or not one that’s regularly covered, those are usually the only ones that require pre-authorization.

Otherwise, your doctor could be writing for things that are not on your plan’s specific formulary – which is a list of medications that are covered by your plan. It’s not impossible that they’re prescribing things that aren’t on the formulary – because some plans change their covered medications the way most people change socks. BUT, unless there’s a reason for that specific medication to be dispensed exactly as written, there’s almost always substitutes for the prescription because almost every plan covers some form of every medication out there. AND if that’s the case, your pharmacist should be more than willing to call the doctor’s office to request the substitution. (It’s usually a simple yes or no.)

If you really feel you have a complaint, you can file with your state’s insurance board (google the one for your state) and they’ll investigate. But, perhaps your beef should really be directed at your insurance company – nobody regulates them and they do whatever they please.

By: Lea

Lea — Wed, 12 Nov 2008 13:32:14 +0000

Most insurance companies don’t have that many pre-authorization medications. They tend to be things like Clarinex, Protonix, and very expensive medications. When needed, it is not a hard thing for a doctor to do. All they have to do is to fill out a form saying you need this drug because the preferred drugs don’t work.
You can contact your insurance company to find out the preferred drug.
I always hated those doctors who would refuse to fill out the pre-authorization forms.

By: mbrcatz17

mbrcatz17 — Sun, 09 Nov 2008 18:45:17 +0000

I don’t know of ANY doctor that ‘preauthorizes’ prescriptions. They aren’t required to do that by their “contract” with the insurance company.

Tell your doctor you want something that comes in a generic, or something that’s been out a few years – not something the pharmaceutical rep just told them about last month. Most of the “standard” generics are going to be covered.

Worst case scenario, print out the list of Sam’s Club $4 prescriptions – it’s EXTENSIVE – and tell him you want him to find something on that list that will work.