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The views and opinions expressed herein are those of the author and do not necessarily reflect those of BehaveNet, Inc.

05/21/2015
Until today prior authorization via covermymeds.com has worked much more efficiently than the old faxed form or telephone review. When a patient asked me to apply for prior authorization I called my favorite pharmacist, and she agreed to obtain a “key” number to initiate the process. I entered the code, answered the questions and thought I had fulfilled my duties.
Wrong.
The patient texted me last night indicating I would need to do more. When I suggested contacting the payer the patient just gave me a number to call. “Meli” at Aetna (or CVS/Caremark?) sounded clueless. I asked about apples. She told me about oranges. They had apparently tried to send a fax to my phone number. When I gave them the correct fax number I received a fax indicating “response time” of minutes via covermymeds.com. Meli told me “turnaround” time would be up to 72 hours, which had already passed. She never acknowledged getting the information from covermymeds.com. She offered to take it over the phone. I agreed. She put me on hold “for a few seconds” at least 3 times, but the whole thing took 20 minutes.
The patient wanted reimbursement for Zubsolv brand buprenorphine/naloxone. The first two questions on the faxed form made sense, but then they asked,
“Is the patient currently enrolled in ongoing outpatient drug addiction treatment program/counseling (e.g., 12-step programs focused on “drug” addiction such as Narcotics Anonymous)?
“[If yes, then no further questions.]“
What makes them ask me? Do they think the patient will lie to them, but not to me? Do they really expect a physician will act as their detective?
This last question really perplexes me:
“Has the prescriber provided verbal verification of patient’s agreed commitment to become enrolled in an acceptable drug addiction treatment program/counseling?”
I am the prescriber. To whom do they think I might have provided verbal verification (whatever that means)? What is “agreed commitment?” The opposite of disagreed commitment?
Surely these multi-billion dollar companies can afford to hire writers who have passed high school English.
Do you think maybe this kind of dysfunction and incompetence and consequent waste might explain our exorbitant medical costs?
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