It was a Friday afternoon at a busy pharmacy in Miami. People walked in with their insurance cards and about half of them walked out without their medications. This was the case for a middle aged man I met while working at a pharmacy ten minutes away from Miami International Airport. He was picking up crucial heart medications for his wife, who he claims had open heart surgery recently.
When I pulled up her profile in the system, I saw that all three medications my patient needed had been rejected by her insurance, showing up as a “Prior Authorization” error. Given the grave circumstances of this person’s health, I decided to call her insurance provider to try to get an override on her medications.
I spoke with three different agents but they all told me the same thing, the patient’s primary health care provider would have to call them to justify the use of these medications (which, according to the husband the medications should have been covered anyway) before the insurance starts paying for them.
The problem with the explanation I was given was that the medications being rejected by the insurance company were not prescribed by the patient’s primary doctor. As a matter of fact, they were prescribed by two separate specialists who treated the patient at a hospital, and both were unavailable at the time as well. I didn’t know how to tell the man that his wife’s medications weren’t available to be picked up unless he paid for them, but that is what he had to do.
In the year that I’ve been working at a pharmacy, I’ve observed cases like the one previously mentioned over and over again. It’s become clear to me that “Prior Authorization” rejections are not the exception, they are the rule.
People who are prescribed multiple medications run into this problem very often. For almost every three medications I see being prescribed, one of them is rejected by the patient’s health insurance.
As worded by a pharmacist I work with, who asked to remain anonymous, “Health insurance providers act like doctors. They decide how much medicine a patient needs, how often the patient can take it and what justifies the patient taking these medications. It’s ludicrous.”
Health insurance providers overstep their boundaries when it comes to people’s health. Even though regulations have been passed prohibiting health providers from dropping people with pre-existing conditions, it is just a drop in the ocean when it comes to making sure everyone gets the medical care they need.
