Prior Prior Authorization

I prescribed Chantix for one of my patients recently. CVS Caremark faxed us a, “CLINICAL PRIOR AUTHORIZATION CRITERIA REQUEST FORM”. It said to complete the form then fax it to them. Once received they would fax a, “DRUG SPECIFIC CRITERIA FORM”.

Why couldn’t they just have sent the specific criteria form in the first place? It didn’t take long to fill out the first form, but why should I have to sign my name twice for one medication for one patient? In addition someone had to take the time to sort through the office faxes and then get it to me, and my nurse had to fax it back, then had to send the fax confirmation to shredding, not to mention that we are paying for the paper, ink and electricity for these faxes.

Chantix only has one use, to help people stop smoking. Why should there be any criteria for coverage? Either cover it or don’t. Maybe they want to know if the patient tried generic bupropion first (actually they subsequently asked if they were taking it at the same time). Well they could have checked their records and seen that the patient was prescribed it in the past and conclude that it didn’t work. They asked if the patient would be monitored for depression. Sure, that is a reported side effect of the medication. But it’s not like CVS Caremark is asking if I know the side effect of all the medications I prescribe.

Pharmacy Benefit Managers like CVS Caremark should stop over burdening physicians with needless paperwork.

Author: Daniel Ginsberg, MD, FACP

I'm an internal medicine physician and have avidly applied computers to medicine since 1986, when I wrote my first medically oriented computer programs. So yes, that means I'm at least 35-years-old!

6 thoughts on “Prior Prior Authorization”

  1. We just got back from 10 days travel and I have on my desk a pile two inches deep of paper from Humanna, Multicare and Safeco. This is opened mail with the envelopes and cover letters trashed.
    Some of it is useful. One from my former employer (retired from MultiCare) requesting continued donations we can no longer afford. One bill for insurance and the rest of the paper is a repeat of information I already have filed. What really irritates me is I gained 10 pounds while on my trip.
    We are all overrun with repeat and often useless information. Insurance and drug companies irritate me on a regular bases. Back to the Y to burn off the frustrations and hopefully some poundage. TP

  2. I love your commentaries. Of course this last one about Prior Prior authorization (as well as others) assume that common sense is common. I think it quit being common about 1963.

  3. Agreed but now there are at east 4 states with legislation forcing the use of a universal form. With few deviations, the legislation are identical – a plan has x number of days to make a decision or request additional information or the request must be approved. So this will cause a great deal more stress on physicians. Phsyician web sites operated by each health plan and benefit manager require multiple sign-ons, remembering passwrds and id’s and a great eal of information to perform varying levels of a PA process. Automated solutions to proces PA’s and provide drug ad therapy specific fax forms are available to speed up the process. Every plan and benefit manager should automate their PA processes – this helps, the physician, he plan and ultimately the member and saves everyone time and money!

    1. I like the idea of a universal form, and have previously discussed this at my local medical society, but I don’t see why it should cause more stress on physicians. Granted, we’d rather not have to fill out any forms, but if needed, the more forms are standard, the faster they can be filled out. Certainly there should also be a similar online form, and preferably data interchange standards so that needed information can be automatically exchanged between computers.

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