David P. Smith: Who is Getting the “Savings”?
Tuesday, June 18, 2013 8:35 AM

I can remember the days when physicians could prescribe whatever we wanted for the patients that we felt was best for them and the relationship between solely the physician and the patient resulted in whatever prescription was written on a prescription and given to the patient to carry to the pharmacy.  Nowadays, due to rampant meddling by the federal government, insurance companies, and pharmaceutical companies, physicians and patients find themselves in a position in which prescription drug costs have sky-rocketed and whatever the physician thinks is best just doesn’t matter as much anymore.  Prescription drugs started costing tremendously more after the passage of the Medicare Part D program almost a decade ago; this is a law that I never supported and still do not.  Many people then used to complain about prescription costs and demanded the government do something.  Well, they did something.  Now we have a mess such that no one can afford any brand name medication unless they are very wealthy. 

For those who have had to get very many prescriptions, the great majority have had the experience of going to the pharmacy only to be told that their insurance company has denied the prescription and “all that needs to be done is your doctor needs to approve it with the insurance company”.  That sounds simple enough, but it isn’t that simple.  Besides that, the fact that your doctor signed the prescription to begin with signifies their approval as far as I’m concerned.  What they want is a prior authorization (PA) number before the prescription will be covered.  To me, it’s nothing more than a road block designed to obstruct passage enough that one turns around and goes back home in frustration, has to turn around and take a detour to another route to avoid the road block, or can finally convince the security guard that passage is needed.  I question where the “cost savings” are going.  We are told that all of this is necessary to save costs, but insurance rates are climbing to highs like we have never seen, so the patients aren’t seeing it benefit them.  Physicians aren’t being benefitted either; according to a recent survey published in the Journal of the MS State Medical Association (May 2013), “the average physician practice devotes one hour of physician time, 13.1 hours of nursing time, and 6.3 hours of clerical time, to the prior authorization (PA) process each week.”  So, the only logical conclusion is that the insurance companies must be keeping it to themselves while their policies result in greater and greater numbers of denials of service to patients.  

We can thank the MS Legislature for trying to help this process to run smoother.  It is astounding to see the government actually do something that causes less red tape and not more.  However, they have done something good for the patients and the physicians with the passage of HB 301 this year to require all insurance companies in the state to utilize one standardized PA form per company.  This new law will result in the over 340 prescription PA forms being now reduced to less than 20.  Insurance companies have to respond to the PA requests within two days now, too.  The next time you have to call your doctor back about being told you need a PA number, maybe the sound you hear on the other end won’t be as much sighing.  Governor Bryant and the MS Legislature are doing a great job helping the people of our state in a variety of ways.  Maybe this common sense thinking will catch on and we can get some of it back into our federal government, but don’t hold your breath on that one.