Need doctor " authorization" to fill a prescription? Huh?

[scottmandue]

So I go in for my checkup, Dr. gives a prescription (I'm in my 50's so he is tracking my blood sugar, cholesterol, BP, etc) I call my insurance and they say "yes, that is covered".
I drop the prescription off at the pharmacist... they call later, tell me it is ready so I stop by to pick it up. They try to charge me full price (about ten times copay), I ask what happened and they say " we need a doctor authorization."
Call me crazy but I would think the fact the my doctor wrote the prescription indicates he has authorized it.
What is going on here?

[Nathans_Dad]

Probably the insurer is requiring a pre-authorization as the medication is not on the preferred formulary for your plan.

[Tobra]

Fax came in this morning about new prior auth form. Glad I don't write a lot of prescriptions

[scottmandue]

Originally Posted by Nathans_Dad

Probably the insurer is requiring a pre-authorization as the medication is not on the preferred formulary for your plan.

Called insurance company before I put in the prescription... they said no problem.

[GWN7]

Got a script a couple weeks ago. Dr typed it into his computer, hit print. It printed the script with a copy of his signature and then he signed it. I asked him about it. He said it was a new system. No more missing script pads. Now more patients copying scripts and shopping them around to pharmacies. Signed in Blue ink so it won't copy well. He said it stopped the pharmacies from calling to check if a scrip was real.

[Tobra]

High security prescription pads, heat sensitive water mark, among other things, make counterfeiting more difficult. Also can't call prescriptions in for vicodin anymore, as of yesterday or the day before. Actually the stuff that you have to use the security Rx pad for expanded a lot too, Class 2 and 3 drugs, if I read it right, where it used to just be class 2.

[jyl]

But scottmandue is probably not trying to fill a Rx for a DEA scheduled narcotic. Or is he? Hmm . . .

[Tobra]

Probably not, narcotics are cheap, no pre-auth generally

They did greatly expand the number of drugs that require one of the high security prescription pads be used though.

[Arizona_928]

Originally Posted by Tobra

Also can't call prescriptions in for vicodin anymore.

Which makes no sense to me? I would think they would crack down on the percocet/oxycodone first. However, my doctor requires a office visit for the later... hmm

[Tobra]

Those were already prescription in your hand on the right kind of paper only in California.

I suspect you could get in trouble if you are writing a lot of prescriptions for people you are not seeing. They track prescriptions for narcotics pretty closely, or give every appearance they are trying anyway. I honestly wonder how efficient they could possibly be.

[Noah930]

Originally Posted by AZ_porschekid

Which makes no sense to me? I would think they would crack down on the percocet/oxycodone first. However, my doctor requires a office visit for the later... hmm

You could never call in a prescription for that in CA. Class 2 narcotic.

In comparison, Vicodin (and now Norco) are class 3 narcotics. Traditionally it was permissible to call those in.

Every state has different laws.

[livi]

Just curious. Donīt you guys have computerized prescriptions? You still have to carry around a piece of paper??
Here we make a digital prescription that is automatically sent to every pharmacy in Sweden and the patient can go to any of them and just pic up there medicine.

One of the few really excellent updates in medicine the last ten years IMO.

[slodave]

This is the US, Markus. We're behind the times.

[livi]

That is surprising Dave.

[slodave]

Don't you owe me some money? Just write a check....

[ddbach]

E-scribing has been available for some time first on handheld palm type devices. I liked Allscripts when we had those. Then came our first EHR and we lost some functionality, couldn't tell formulary from non. Now on our second EHR and much better but switches everything to generic and a PIA when I want Dispense as written.
Tramadol went scheduled recently too so changes in how scripts are handled for that. Colleagues frustrated with patients not understanding the change. State laws regulate how scheduled narcotics Rx can be presented. Here an actual physical signature is required hence printed Rx vs e-scribe. Several years ago a support staff was caught printing scripts and forging docs signature. I believe the narcotic prescribing pattern monitoring helped sort that one out.

[ddbach]

Prior auth can be a pain, explaining my decision making as a specialist to someone with little or no understanding of my field. Varies with insurance co and which plan. Then which pharmacy has the contract from said ins co vs where the patient wants to go. Staff spent 30+ min this week going round on a generic timolol eye drop that pharmacy said needed auth, ins co said no patient doesn't have Rx coverage, patient said oh yes I do and was right so needless delay in treatment initiation.