Prior authorization requires permission to be sought before prescribing critical drugs, which could cost lives, doctors say

Prior authorization requires permission to be sought before prescribing critical drugs, which could cost lives, doctors say

In the midst of the worst overdose epidemic in US history, addiction medicine specialists say a bureaucratic hurdle is adding to the difficulty of getting people in treatment: an insurance industry tactic called “prior authorization”.

Loathed by doctors of all stripes, prior authorization requires healthcare providers to seek permission from insurance companies before they prescribe a treatment. Doctors in addiction medicine said the requirement is both unnecessarily burdensome and could cost lives.

“We have patients who are having overdoses once a month because of the fentanyl being in the drug supply,” said Dr Alain Litwin, a clinical researcher and executive director of the Prisma Health Addiction Medicine Center in South Carolina. “This is the crisis of our time – overdose rates are rising every year”.

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Prior authorization is especially harmful in one program: Medicaid. More than half of the people who received treatment for opioid use disorder in 2017 used the public health insurance program for the poor and disabled, according to the Kaiser Family Foundation.

  • Brkdncr@lemmy.world
    27·
    10 months ago

    I had to go through “prior auth” hell. Took me 3 months to get started on a treatment they my dr and I wanted. Some faceless person in the cloud kept denying it to the point that the company that made the drug brought in a person to help get the paperwork figured out.

    This all stems from healthcare being tied to capitalism. Drug manufacturers want to make money and market their products to drs and patients. Insurance companies don’t want to pay so they employ desk jockeys to shuffle paper around.

    In the end insurance is paying for a chunk of it but I have paperwork from the drug company showing they are willing to discount the drug by up to $13,000 a year for anything not covered by insurance.

    And since my insurance company is greedy they don’t add that discount they aren’t paying for to my deductible limit like other drugs are.

    It’s all a scam.

  • cybervseas@lemmy.worldEnglish
    221·
    10 months ago

    Yikes. There are times when PA is fine, but not when your members need treatment for addiction!

    I wonder insurance companies found it’s cheaper to let their opioid-addicted members OD and die…

    • assembly@lemmy.world
      9·
      10 months ago

      Yeah I think you nailed the motive on this. Addiction probably impacts overall health which also drives up their costs for non addiction related coverage to the same people. Someone at the insurance company did the math on the money saved by people with addictions dying vs having to cover them for long term care.

    • escew@lemmy.world
      19·
      10 months ago

      I watched an episode of Law and Order SVU where the detectives march in and arrest a CEO of an insurance company because they kept denying something or other. Immersion ruined!