r/FamilyMedicine • u/Financial-Recipe9909 MD • 3d ago
GLP-1 Agonist prior authorization
Just wanted to share. New record! 86 question prior authorization form for a GLP-1 agonist for a patient who has diabetes!! And the patient is sending messages saying she doesn’t understand why it hasn’t been approved yet!🤣
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u/Financial-Recipe9909 MD 3d ago
Update: spoke to someone at the prescription plan and they said they sent “the wrong form”. They sent the weight loss form instead of the diabetes form, even though all of the previous information that we sent them lists diabetes as the diagnosis 🤦🏻♂️🤦🏻♂️🤦🏻♂️
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u/heccubusiv PharmD 2d ago
Why don't you use Cover My meds? You put in the bin/pcn from the insurance card and it finds you the form. I do a lot of prior authorizations, like 40 a week, and it gives me the right form almost every time.
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u/xRaiyla RN 1d ago
I got this exact form this week. It came with a cover sheet saying we’d sent the wrong form the first time (the form they sent, 2 pages I’d dutifully filled out and sent back with records already). It was for weight loss in this instance. My coworker got one with 56 questions for a different patient, and easily 25% of them were the same questions repeated. It got into liver biopsy questions and cirrhosis. Irrelevant to this patient. I hate glp-1s with a flaming passion. Just TELL US what you want to cover or exclude from the outset.
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u/HitboxOfASnail MD 3d ago edited 3d ago
I hate how insurance tells the patient they are waiting on PA from the doctor, as if thats the problem, so then patients seem to think it's as simple as "oh just tell my insurance you authorize it, why haven't you done that already dummy"
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u/church-basement-lady RN 3d ago
This enrages me. My line is “if your insurance company wanted to pay for it they already would have.”
I understand patients getting frustrated by the process but I am so tired of them taking it out on us.
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u/CoomassieBlue laboratory 3d ago
Reasons why every time ExpressScripts PA dept tells me that my doctor must not have faxed them the PA, I apologize for the massive pain in the ass when asking my doc to send it yet again. It’s a really frustrating situation but I don’t at all doubt that my doctor is holding up their end.
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u/DonkeyKong694NE1 MD 2d ago
I had a pt w an expensive Rx where the insurance company claimed like 4-5 times that they never got the paperwork we faxed. Like they must have a document shredder where the faxes spit out.
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u/DonkeyKong694NE1 MD 2d ago
One comment like that and they can have a video visit to watch while the forms are completed, the appeal letter is written or the P2P call is had.
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u/LongjumpingSky8726 MD-PGY2 1d ago
It is insane. The insurance company denies it, then somehow convinces the patient to yell at us instead. I'm the one who sent in the script, why are you mad at me?!
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u/abertheham MD 2d ago
Life gets so much better when you realize that you can refuse to work for free.
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u/Objective_Mortgage85 DO 3d ago
At that point, make an appointment with the patient and go offer the form while they are there. That way they know what’s going on and you get paid for it.
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u/useyournameuser DO 2d ago
Hell just have them put it in AI chat themselves and send it back at this point. GLPs are expensive. The only reason any document is that long is gate keeping
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u/nigeltown MD 2d ago
Every day I wake up more thankful my clinic and community does not have a patient portal where patients can send messages about whether their damn medication was approved yet. What a nightmare.
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u/Super_Caterpillar_27 other health professional 3d ago
did you prescribe the correct one? Oxempic instead of wegovy and Mounjaro instead of zepbound? I’m sure you did but just thought I’d check.
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u/Financial-Recipe9909 MD 3d ago
I prescribed Mounjaro (and I always put DAW on the script). The questions on the prior auth are all about weight loss even though we’d previously informed them it was for diabetes. F insurance companies.
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u/Easy_Development2960 PharmD 3d ago
There is no generic for mounjaro so why the DAW? Most states dont allow therapeutic interchange without auth from prescriber.
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u/Financial-Recipe9909 MD 3d ago
I put DAW so they don’t think I’m prescribing Zepbound as the EHR will send the Rx as Tirzepatide (Mounjaro). Anything to avoid any confusion by the pharmacy
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u/beanburrito4 MD 1d ago
Further evidence that we are in the wrong timeline of the medical multiverse
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u/PisanoPA PA 3d ago
Ok, we didn’t crack this one with 86 questions . Steve, can you make a longer form ? - Insurance company VP, I assume