Prior authorization article was incomplete

November 25, 2013

A reader writes that a previous article in Medical Economics did not include some relevant information.

Your article on prior authorizations (“Curing the prior authorization headache,” October 10, 2013) leaves out a few issues. I completed Drug Addiction Training Act 2000 training years ago. My DEA number was altered to a special number to prove this. The only indication for the buprenorphine I can prescribe is opiate dependency. Since this is a maintenance drug, the people are on it indefinitely.

I write prescriptions confirming that they need it. Now, I get a call from the pharmacy that I need to call for preauthorization. I call and go through the phone tree. Then I get someone demanding the group policy number. I then have to go to the Internet to fill out the form. This requires my calling for an ID number, etc. My DEA number has the X code showing I completed the course. So why do I have to reanswer questions when the prescription has the DEA number confirming the information?

Lastly, no one in your articles commented upon the case Gibson vs. Medco. The judge ruled that Dr. Gibson was to be reimbursed for time spent in prior authorizations for medications when the argument was over the economic issues and not patient safety.

When I cite the decision to pharmaceutical companies, I have been told that they do not accept the judge’s ruling. I ask if the purpose of the [preauthorization] call is to control costs. When they say yes, I ask if I am paid for my time. When told no, I ask if they are being paid for their time. They say they are. So I say, ‘then you want me to work for free to save the pharmaceutical management company money?’

I often get told that I have an attitude problem and am a bad doctor.

Aaron Levine, MD

Houston, Texas