posted on Jul, 12 2013 @ 09:07 PM
Long time lurker here, and I figured it would be a good idea to post on this to clear up some confusion. I am a pharmacist who has been practicing
since 2009, and I believe what we are discussing here is called a Prior Authorization. This has been going on for some time and has nothing to do
with ACA. An example would be if a patient gets a rx for say Crestor (which is not available in generic form yet, and very expensive) the insurance
company will reject on my end (at the pharmacy billing end) and say they prefer to start with simvastatin, pravastatin or atorvastatin.
From here, I would faxed the Dr the rejection, at which point the Dr could request an override. It is not always approved. I have some patients on
chronic pain meds, and they have to be authorized every quarter, some every year, and some even every month....it really sucks for these patients.
The approval process is slow and can take a week or more. That is not a good thing for someone who has been taking strong pain meds to be without
them for a week or more......
Will this practice increase as a result of the ACA??? Good question. My instincts say yes, but I cant say for sure.