Carol’s Story

Carol Rose Kahn is a registered nurse who has seen firsthand the dangers associated with prior authorization issues. She works at the University of Michigan, where she seeks prior authorizations for patients struggling with opioid addiction, most often for a costly drug abuse deterrent called buprenorphine-naloxone.

“Recently, I spent more than two hours getting a prior authorization for a patient because Medicaid Magellan would not allow a covering doctor to write the prescription,” Carol said. “Why? Because the covering doctor’s name was not on the prior authorization.”

The battle Carol waged on her patient’s behalf not only caused lost patient care time and unnecessary administrative expense, it also resulted in a delay in the patient getting the necessary medication.

“He finally ended up paying out of pocket,” Carol said.

For Carol, there’s more at stake than just insurance. Patients facing addiction may choose to walk away from their treatment options or, worse still, try to find alternatives on the street.

According to the New York Times, “Patients whose lives have been transformed by the medication say they feel stressed by the struggle to get and pay for treatment…not to mention the public and private insurers that restrict the dosage and length of treatment, despite studies showing that higher doses improve treatment retention rates and that quitting [the drug] often leads to relapse.”

Carol says the prior authorization process has a huge impact and, worse still, is constantly changing.

 

“The requirements and formulations covered are always moving around,” Carol said.  “It’s time for a real fix.”

David Pridniaarchive