One of the most frustrating experiences as a patient is arriving at the pharmacy to pick up your medication and being told that a prior authorization is required. If you have never experienced this before the process can be especially confusing and aggravating. Unless you decide to pay cash for your medication or your doctor decides to change your therapy it can also involve a significant delay before you can actually get your medication.
Prior authorization is a process where the insurance provider wants more information from the doctor before they will pay for a medication. This process typically starts at the pharmacy when the staff there try to bill an insurance plan for a drug. The insurance will then send the pharmacy a rejection notifying them that a prior authorization needs to be completed. At this point the pharmacy will contact the doctor to let them know they must complete a prior authorization if they want the insurance company to cover the cost of the prescribed drug. The doctor must then answer some questions about the use of the prescribed medication and send those answers to the insurance provider. Finally, the insurance provider must review the doctor’s response and decide if they will pay for the medication or not. Thankfully this process is quicker than it used to be as many of these interactions are automated or electronic. Typically this process can take anywhere from a day to a week to complete, although times may vary. If a patient stays on their medication for an extended time it is likely that the prior authorization will need to be completed again at some point. Many plans require prior authorizations annually while some require them more often.
The main reason insurance plans institute prior authorization is cost savings. Plans want to review the use of high cost medications and make sure they are being utilized appropriately. A common way they do this is called step-therapy. Step therapy means that the insurance provider will require a trial of one or more lower cost medications before they will pay for a high cost drug. Many insurance providers require prior authorization for brand name drugs if a generic is available. Insurance plans often prefer a certain drug within a medication class due to cost and require providers to complete a prior authorization if they write a prescription for a different drug in the same class.
Prior authorization can be frustrating for both patients and healthcare workers. Despite that the practice isn’t going away anytime soon. If you want to be more informed about which drugs will require prior authorization on your health insurance you can request a copy of your insurance formulary which will show you which drugs your insurance plan prefers. Drugs on this list will be less likely to require a prior authorization.
PharmD candidate 2018
It seems like every year there are several outbreaks of meningococcal infections on college campuses across the country. This disease is caused by a bacterium called n. meningitides which can infect both the brain and the blood. Although meningococcal infections are rare even with treatment this infection can be deadly in 10-15% of patients. Those who survive can experience permanent disabilities like amputation, hearing loss, brain damage, kidney damage, and scarring from skin grafts. As a student at The Ohio State University you are required to be vaccinated for meningitis before you can live in university housing. This vaccine covers meningitis type A,C,Y, and W-135. It does not cover meningitis B which causes nearly half of meningitis cases in patients aged 17-22. There are currently two vaccines on the market for meningitis B, Trumenba and Bexsero. Both vaccines are approved in the United States for patients aged 10-25 for the prevention of meningococcal type B infection. Although the medication is approved for 10-25 the Advisory Committee on Immunization Practices and the CDC give these recommendations.
These vaccines are recommended for patients ten years and older who:
- Are at risk due to a type b outbreak
- Have a damaged or removed spleen
- Have an immune system condition known as “persistent complement component deficiency.”
- Are taking eculziumab (Soliris)
- Routinely work with N. meningitides.
There is an additional recommendation that the vaccine may be given to anyone aged 16-23 with a preferred age of vaccination being 16-18. This allows patients and their healthcare providers to determine if they want the vaccine.
Both vaccines require multiple doses. Bexsero is a two dose series with the doses being administered at least one month apart. Trumenba can be a two or three dose series depending on your risk level for meningococcal B infection.
PharmD candidate 2018
Are you on a daily medication or learning to handle your own prescriptions for the first time? Do you have a prescription that you need to continue taking but you are out of refills?
In most cases, if you are out of refills it means that your provider felt at the time of writing your prescription that a follow-up visit was indicated in this period of time. We generally write most on-going prescriptions with the number of refills that fits the standard of care for following that health condition. Sometimes there are lab tests or physical findings that need to be checked periodically.
You don’t have time to come in for an appointment right now?
Ideally you would be able to make the time to come in for a visit so that we can provide the best possible care. However, we too were students once and understand your crazy schedules, so you can either message your provider through MyBuckMD or call the health center to leave a message with your provider asking for an extension until you can make it in for an appointment.
How to avoid running out of medications?
Plan ahead! If you notice that your medication is running low, take a look at the bottle for any refills. If you see no refills remaining, make an appointment with the prescribing provider as soon as you can.
Don’t see an appointment on-line that fits your schedule?
All available appointments do not show up for on-line scheduling. So if you are having trouble finding an appointment with your provider, please call our appointments line at 614-292-4321. Our appointments associates will be happy to help you find the next available appointment that fits your schedule.
Ryan Hanson, M.D.