In a note sent to my congressional senator:
I am a psychiatrist in Maryland and I have become interested in the issue of the hoops that insurers require physicians to jump through to get preauthorization for medications. Given that medicine, and psychiatry in particular, is a shortage field, it seems criminal that insurers can require physicians to spend hours requesting preauthorization for medications. If the process were simple, this would not be so bad, and certainly some medications are quite expensive with cheaper available alternatives, but the process can go for weeks, during which time a patient can't get medications.
There are also many times when physicians are required to make these calls -- often taking 20-30 minutes-- for medications that cost only a few dollars a month -- the obstacles are mindless and they are hurting the delivery of medical care.
Each state regulates this, but the issue often crosses state lines. I have been trying to get a medication approved for a patient for weeks now -- I practice in Maryland, the patient lives in an adjacent state, her insurer is in Iowa, and the pharmacy oversight agency is in Nevada. I've been required to make multiple calls, all with hold times, where I am asked the same questions and told that the patient does not have medical necessity for the medication. They ask the same questions at each step and tell me that while the case for the medication is good, they have no leeway to authorize it. I have communicated with the CMO of the insurance agency who simply confirms that this is the process.
The process is well-illustrated by Danielle Ofri in a New York Times article last year:Adventures in Prior Authorization. What she doesn't say is that there are no limits or regulation on how long an insurance company can delay or how many hoops can be set up.
I know Senator Cardin is sensitive to mental health issues. Rep Murphy of PA has a bill in congress -- the Helping Families in Mental Health Crisis Act -- where he discusses the shortage of psychiatrists, but I don't believe it addresses this issue.
And in one of several emails to the health insurer's chief medical officer:
Apparently I'm not the only frustrated psychiatrist, Dr. George Dawson at Real Psychiatry has plenty to say on the topic here: