Marlynn’s Story

I am a Medical Assistant in Dermatology, been working for the same company for 7 years this August. I took over medication prior authorizations about 4 years ago. In my experience medication authorizations are lengthy and delay patient care. We can be the best, but the delay in response on medication determinations makes us look bad. I have noticed its often times the reviewer who is making the decision likely denies because they have lacked considering the clinical notes and rational provided in why we need this to be approved. If you can imagine a patient is seen, prescribed a medication insurance requires authorization. One week later after submitting still don’t have an answer. We call, only to find out still pending. Ten days in and denied. We can only hope insurance understands in resubmitting we are confident they made a mistake and didn’t review clinical details. Formulary options are sometimes not enough. Insurance seems to want to treat patients at a step up therapy process, and that’s not fair. Patients are uncomfortable. Not to mention their ability to function in their every day jobs, or hobbies.