Home Forums Discussions General Discussion covermymeds.com

Lately I have been getting lots of requests for Prior Authorizations for medications which I never used to get. Even for tylenol with codeine for postop patients! Some of my patients have not gotten their pain meds for 3-4 days after their surgery. This is ridiculous.

Apparently this website helps with prior authorizations for meds.
Does anyone use this? does it work?
Does AC have an interface for this?

"Covermymeds" -- HAHAHA.
That is a total scam, run by a Silicon Valley hedge fund.
"Free" to doctors -- just a little of your time and your staff's time, which of course, is worth nothing.
Presumably paid for by the insurance companies, who make money by denying claims and by the pharmaceutical manufacturers who profit from keeping the prices higher than free market value when they get the doctor to "justify" the need for a medicine.

Today, I couldn't get doxycycline for a patient -- "not on formulary".

This won't stop until doctors en masse start refusing to comply with requests for prior authorization for routine items, and demand payment for the work involved in the few cases where it truly makes sense.

So far, it has been my observation that doctors love to whine, but can't be counted on to do anything to actually demand and require improvement of the situation.

Actually, we have had a very positive experience with Cover My Meds. Basically CMM saves a lot of time with the prior auth process. The first time-saver is in finding the appropriate form to complete. You enter the name of the drug and the insurance company, and it pulls up the form for you. Next, it saves a ton of time with entering repetitive information. Once you are registered, filling in all of your info (address, DEA, phone, etc) is basically automatic. In addition, it provides some guidance with what info is needed to obtain the auth so you don't enter in too much.
All-in-all, we find it to be a very useful service.

As to their funding... I think it primarily comes from the drug companies. For better or worse, their interests are aligned with ours on this issue: they want us to be able to get the drugs that we prescribe for our patients, so in that way it is a win-win.

I suppose it is an option to refuse to do prior auths for meds altogether; I know some take that approach. I think that if you decide you ARE going to do them that CMM is a major time-saver.

Jon --
I don't disagree that it can be a timesaver.
But we shouldn't be wasting that time in the first place!
Drug companies are only interested in keeping the price high, and one of the ways to do that is to require "prior authorization" -- even of common, generic meds to force the insurance companies and the government to pay their inflated prices.

They (or their marketing departments) have simply become intolerable systemic parasites.

Any cooperation with "prior authorization" for anything other than unusual and life-sustaining meds is simply enabling behavior. At your expense, with the patient held hostage.

I is unconsionable, what they do.

So I am not the only one refusing to do Prior Auth? Perish the thought! I put the burden on the patient. I ask them to talk to their insurance and ask which meds are ok, give me a list, and then I will prescribe it. I only prescribe meds for postop pain and nausea which makes it easier. Occasionally I prescribe for treatment of HP found on endoscopy. Thanks for the info to all.

PS. I make no money from CMM nor do I endorse it in anyway. I just wanted to find out if anyone uses it and how helpful it is. I say so because I realized now that my initial post kinda looks like a plug in for it. Sorry.

I have never used Cover My Meds, and I abhor doing prior authorizations, but I wanted to shed some light on some of the issues with insurance companies and prices for medications. Sometimes the price of medication actually goes up or requires prior authorization because the medicine is in short supply. My husband used to work for a drug company that sold meds to pharmacies, and he'd see it happen all the time. Doxycycline is one he specifically mentioned to me because I was annoyed by it, too. Its price shot up astronomically because it was in short supply. So sometimes there's a reason for prior authorizations and increased prices for generic or established drugs. That being said, most of the time, prior authorizations are ridiculous. One time Medicaid wanted me to give prior authorization for Ranitidine! It's a $4 drug at Target and it's available over-the-counter! That was one prior authorization I definitely refused to do!

gcarcamo -- I am delighted there is at least one other physician that won't kowtow to "prior authorization". If we could just spark a revolt -- maybe doctors could take back the playing field.

ALR -- "prior authorization" doesn't help resolve the "shortage" of doxycycline. It justifies the market manipulation that caused it.

Today I refused to grovel to PA -- couldn't prescribe doxycycline, so I prescribed clindamycin instead. If the patient gets necrotizing colitis and costs the insurance company a bundle, it will be too bad. A shame that patients have to suffer for our hard headedness.

I tried Covermymeds and didn't find it helpful. With my office setup it took more time than what we were doing with PAs.

PAs are a hassle. It will probably get worse--it's just part of the reality of caring for patients. Ah well.

I was just about to post when I saw this identical thread.

I am inundated with requests for medication prior-auths. I received an auth request for 5 mg of Prednisone, recently. I fill up the 'cover my meds' request and then the insurance carrier sends me their own form. How are you dealing with this?
I have a bare bones operation and I have to do the form filling. The MA does not know the clinical issues. I have heard of practices charging $25 for these. Is scheduling F/U visit for form filling and discussing medication options kosher?

Zak--
We are dealing with parasites and criminals (insurance companies, drug companies and all the hanger's on like Express Scripts) -- they aren't interested in better medical care, or less cost to patients. They are only interested in profits for themselves.

Of course requiring people to come in for a visit to fill out forms (if you really think it is your job to fill out forms) is "kosher". You have to get a lot of information, and you have to get it from the patient, or else you can't properly fill out the form.

This is war -- but so far, the doctors are mostly just lying down and taking it. I long for the day when the medical profession stands up as men and women and tells these people to shove it.