I am a humorous example of this prior auth stupidity. My doctor has prescribed a medicine for me that is on a controlled substance list. The max prescription is a 30 day supply. My insurance requires mail order after three fills. But they also would not approve the 30 fill under this prior auth crap. And they insisted on faxing the forms to the doctor instead of allowing email or some web page.
This drug costs about a penny a pill. And they were refusing to approve a 30 day fill. But they were happy to allow a seven day supply.
So for the last four months I have had to go to the mail-order pharmacy’s website every week to “refill” my seven day supply so they could mail me seven pills and charge me nine cents. Their stupid slow-marching of this prior auth is costing them the price of postage minus the nine cents they have been billing me.
They finally came to their senses last week and approved the prior auth. Now they get to bill me 39 cents for 30 pills.
If they pull this crap over pennies, it is not a surprise they also pull this crap over something costing thousands.
I’m not sure what state you live in, but typically the first fill or two are one week “trial periods.” If you need it after that, typically they cover it 30 days at a time. Cor CII controlled substances, 30 days is max. I’m having this problem with one of mine, as it’s on backorder. Joy.
Prior authorizations might be necessary in that case. I also don’t trust mail order; stuff gets stolen that way.