Medscape: Prior Auth Is a Self-Inflicted Wound; Is There a Way Out?

From Medscape: By Ravi B. Parikh, MD, MPP A few months ago, a close friend called me in a panic. Her mother had been on an oral treatment for relapsed multiple myeloma for nearly 1 year. Originally, she had been prescribed the oral pill pomalidomide as part of her regimen, but it had caused cytopenias, constipation, and nausea even at lower doses. Now, she was tolerating her new pill, ixasomib, quite well. Then, without so much as a letter from her insurance company, the patient’s pharmacy called to tell her that ixasomib was no longer covered without a peer-to-peer conversation given its cost. The peer-to-peer left the oncology team and patient even more frustrated. After leaving the team on hold for nearly an hour, the insurance company denied the request for ixasomib. The hematologist conducting the peer-to-peer did not seem to understand why the patient had discontinued her previous medication. Ultimately, the patient was forced to return to the old less expensive drug. Since going back to pomalidomide, she has needed multiple dosing changes to manage the intense drug side effects. I wish that stories like this were uncommon. I am often reminded of the ongoing challenges related to prior authorization when I see colleagues regaling the Twitterverse with their latest horror stories about an insurance company rejecting standard-of-care treatment or imaging. The data confirm the frequency of these experiences. Among a general cohort of physicians, the American Medical Association has reported that most practices complete 29 prior authorizations per physician every week and spend on average 14.6 hours, or nearly 2 full business days, of staff time each week on these requirements. Read more at Medscape.