One of my patients (who labels himself a #PriorAuthSurvivor) diagrammed the unnecessary complexity of trying to get his medication approved on time 👇 Rinse & repeat and this is a cyclic nightmare that has nothing to do with chemo but rather the bureaucracy of US healthcare

Dec 15, 2023 · 2:16 PM UTC

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The point is to not provide treatment.
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And to keep the otherwise moribund fax industry afloat
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This is amazing, and also such a sad reality.
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My thoughts precisely
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Oh my God!!!! Who is this person? Seriously this is the best!!!!! – at Bismarck, ND
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I particularly enjoyed step 8
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I am not going thru this now, but it brought back such memories it made me cry. For me, steps 19 to 24 were the worst, with a few extra steps thrown in to keep me hopping! đź©·#PriorAuthSurvivorđź©·
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The interminable waiting … so glad you made it through, though
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not sure this is bureaucracy tbh....rather looks like an algorithm designed to make it as difficult as possible to access the care you are entitled to...
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<Franz Kafka has entered the chat>
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Nope, never again...
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You forgot to mention that Cigna owns Express Scripts, which owns Accredo. So the example ends with the health plan paying itself for the medication after increasing costs due to administrative bureaucracy. Then it will claim its vertical integration saves money. #PBMreform
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They're trying to make it so difficult for us to get medication that we give up and off ourselves instead. Save on disability and medicare.
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Having just changed jobs, I am now having to go through this with several of my wife's meds. In some cases they want us to try things we did multiple years, doctors, and insurance companies ago.
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I recently spoke with a medical director of a major medical testing company. To introduce a new test, they need to contract with 1600 different payers. The toxic inefficiency of the American medical insurance system is obscenely costly.
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That's a new one for me #PriorAuthSurvivor! Your patient is really something, making sense of the whole crazy process. It's one of those situations that's so frustrating you just have to laugh to avoid crying...
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I am a mom to 3 girls with #IBD. We are #PriorAuthSurvior(s)! I am just about to step 15 for kid number 3. Our group # changed for this plan yr - and all 3 prior auth’s for the girls had to be resubmitted this month. I have lost track of my hrs trying to get their meds set up.
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This feels about right - I have Cigna insurance, and they force me to use accredo for a specific medication. I take it every 8 weeks for the last ~16 months, and they've yet to get it to me on time without at least ordering issues
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it should be 1-2-3, done.... What's funny is the economic and time cost to everyone here—including the corporations—has to be significant. Anyway, love the visual!
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I saw my GP today. She wrote a prescription. It needed to be authorised. She rang the government authoriser. They said yes. I got my script on my phone and went to the pharmacist and got my prescription filled. The End. I live in Australia.
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.@ACRheumDC @MarilynHeineMD ⬆️⬆️Please feature incl diagram.
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This patient needs to publish this work in @JCOCCI_ASCO.
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That is a brilliant diagram... But bloody hell!!!
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Hmmm…looks like a “business model” you would never ever construct on purpose (in any “business”) unless… #IncentivizeBadBehavior?
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This diagram NEEDS to be presented at next ASCO.
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I’ve can’t even count the number of times the appeal department-who you can’t contact directly-approves an appeal but doesn’t load it into the system with the PBM so the pharmacy can run it. Then more hours on the phone to try to correct it
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Look up fotivda and it’s limited distribution. Optum can’t get it but won’t let the pharmacy that can get it fill the script because they are out of network.
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I was just diagnosed with asthma and the inhaler my doctor prescribed me costs $567!! It’s ridiculous that we have to pay this much for a drug that will help me! I can’t afford it so my doctor is trying to find something. My insurance doesn’t cover it!
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Does nothing except keep more money in the insurance company’s pocket. Money that they are contractually obligated to expend on the patients’ behalf. But every second they delay is better for their profits. Dismantle the insurance companies.
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For 4 months I've been going in an endless phone call loop of 3 thru 14 trying to get my meds. They never told my doc that the request is supposed to be submitted directly to the 3rd party. Can't wait to get to phase 2!
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