Hello, @Atul_Gawande. Are you kidding? Getting prior auths for cancer pts w pain is the bane of my pal care existence.
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Pricier branded opioids do have prior auths with many plans, i.e. the long-acting ones, especially some abuse-deterrent formulations. In the past, the inexpensive generic short-acting opioids did not, but that is starting to change to enforce new RX guidelines.
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Have also done PAs for opioids including hospital discharges when the patient was admitted on the same maintenance opioids for chronic pain. Insurers make it hard to treat anybody but the evidence is clear - much harder for anyone with mental illness or addiction.
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I’ve done PAs for both, can count on one hand how many times its changed mgmt. need to take off my shoes to show how many hours I’ve spent related to these... just over a few months...
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Publicly traded for-profit health insurers have a fiduciary (legal) responsibility to prioritize shareholder profits over patient and physician wellness. This is antithetical to any healthcare system and is nearing its breaking point.pic.twitter.com/V50lpuHdlC
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Neither the Rx for 4 days of opiates written by the discharge M.D. when my friend left the hospital post hip replacement 2 days after surgery nor the follow up Rx written by the surgeon were paid for by the Ins. Co. because of no prior auths. this for an opiate naïve patient.
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You cannot let physicians off the hook. How did a group of supposedly scientifically trained professionals fall for the hype about the safety of opioids? Aren't doctors supposed to demand evidence before embarking on a prescription spree?
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But absolutely, the health industrial complex is only fundamentally concerned with human welfare, and is absolutely not influenced by the incentive to maximize profits.
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THAT'S SARCASM, RIGHT ??
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This is a prior authorization form for opioids from Optum https://professionals.optumrx.com/content/dam/optum3/professional-optumrx/resources/pdfs/ORxCommForms/Short-ActingOpioids_Comm.pdf …
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I think prior auth is primarily about cost. Opoids are very inexpensive under most insurance plans (<$5 for standard prescription) because they're off-patent & generics exist. For manufacturers, big money is in chronic pain patients. Treatment is much newer & likely to be costly.
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Most CPPs I know always try to stay on generics to save $$$ , most have serious financial stress.
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