Can I Get Prior-Authorization To Kick Your Ass?

Whoever decided to put high-school dropouts in front of a computer with headsets on to speak with physicians or medical providers to discuss and approve or deny drugs or other therapies for patients was a real fucking genius.

Let me tell you how it usually goes when I try to get a wonderful, newer drug approved for my patients. I love Byetta and prescribe a ton of it. It is the only commonly-used drug for type 2 diabetes that lowers glucose AND helps patients lose weight. Unfortunately, since Byetta is newer and more expensive than your typical, cheaper generic diabetes drugs that cause FURTHER weight gain in these already-obese patients, it often required pre-approval from insurance carriers. We'll start with how the prior-authorization call usually goes (in reality), then we'll slide into the 'Twilight Zone' where both me and the insurance company customer service rep say what we actually WANT to say to one another.

Dr. Lofty: Hi, I was asked to call to get prior approval for Byetta for my patient.

CSR: Yes?

Dr. Lofty: Yes?

CSR: And your question is?

Dr. Lofty: My question is, what information do you need to get this drug that I believe my patient should be on approved?

CSR: Yes (pause, looking up algorithm for questions to ask caller under 'Byetta protocol'), so why does this patient need Byetta?

Dr. Lofty: Because they have gained 20 pounds over the past year on Actos and glyburide and in my experience I can get this patient's hemoglobin A1c down about 1% with about 20 pounds of weight loss using Byetta and getting them off of these other drugs.

CSR: I see. And what is the medical justification?

Dr. Lofty: I just told you the medical justification.

CSR: Yes, well, I'll need to fax over a two-page prior authorization form that will need to be filled out completely along with the last three chart notes documenting failure to achieve control with....

SLIDE INTO TWILIGHT ZONE...

Dr. Lofty: Hey fuckhead with your G.E.D. diploma hanging on your cubicle wall, I went to fucking medical school for four years, did three years of residency training plus a chief resident year, and have been practicing diabetes almost exclusively for ten years. My experience tells me this patient needs Byetta and I want him to have it NOW! Losing weight and shrinking the waist probably reduces cardiovascular risk in patients with type 2 diabetes.

CSR: Sir, we really don't give a flying fuck if your patient loses weight. We would prefer he or she remain on the cheaper, generic drugs that they are currently taking.

Dr. Lofty: Well, the patient sure would feel better in the long run losing twenty pounds and losing about 2 gallons of fluid from their legs.

CSR: Again, don't give a shit about this patient's quality of life. Too expensive to use this drug. This person won't be on our plan in two years, so we could give a rat's ass whether or not they lose weight or feel better. They'll be someone else's problem in two years.

Dr. Lofty: You're a dirty fuck stick...I hope you gain 200 pounds today and develop type 2 diabetes. You'd be begging me to put you on Byetta and I would give you shitty drugs like glyburide and Avandia to make your fat ass fatter!

CSR: Whatever. You doctors are so arrogant.

Dr. Lofty: Hey, Einstein. Can I talk to your supervisor? I want to get the ball rolling on a prior authorization to come down there and kick your sorry little ass!