Prior Authorization Rejections

This page covers Prior Authorization Rejections (also known as a PA.) It describes what they are and why they happen.

Insurance companies sometimes do things which are not always in the best interest of the patients they insure. One example of this is is a PA.

A PA happens when an insurance company blocks coverage for a patients medication and requires the prescriber to contact them to make sure that this is what the doctor wants.

Basically, the doctor has to jump through the insurance companies hoops in order for them to pay for it.

This makes no sense at all to me, since the doctor already prescribed it… of course they want them to be on it! But the insurance company wants to block payment for this medication.

One possible reason for this may be that there is a cheaper alternative medication that the insurance wants the patient to try first.

Possibly the medication that was prescribed is a brand name medication that is expensive and the insurance company would like the patient to try an alternative medication that is a generic so that it would cost less.

Or, another reason for the PA could be that the drug manufacturer of the prescribed medication doesn’t have a kickback as good as from a different medication's manufacturer.

Yes, the drug manufacturers are working with the insurance companies.

This type of partnership often interferes with successful patient treatment and successful patient outcomes.

Sometimes a patient will really be in need of an important medication, but will be unable to begin the prescription regimen because the insurance company gets more money for covering a competing drug manufacturer’s medication.

PA's can take from 30 minutes to days or even weeks to get approved. The patient is often left in the middle of this whole mess.

They are often confused about why this has happened, or they may be angry at the insurance company. And they have a reason to be mad since their treatment has been delayed. A PA is a major inconvenience for everyone involved.

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