Unfiltered Story #195948

, , | Unfiltered | June 8, 2020

(Pharmacy worker here. On some prescriptions, especially high cost prescriptions or ones deemed a controlled substance, the insurance will put a block on the prescription and the phrase “Prior Authorization needed,”or PA, will pop up. This means the prescribing doctor has to call the insurance company and explain the need of the medication for the insurance company to cover the cost. It’s a hassle, especially if it’s a maintenance medication, and usually takes a few business days to clear. Though once a PA is acquired, it’s deemed good for 3-6 months, so is only really necessary a few times a year. I’m working at the register one day when this happens to a woman.)
me: I’m sorry ma’am, but your [prescription] has a PA, and we can’t fill it right now.
Customer: what’s a PA?
(I explain what it means)
Customer: So can’t I just pay for it out of pocket? How much is it?
Me: I don’t have the price, but if you go to drop-off, they can help you with that. Though the PA will only take a couple days to work, and it lasts for a few months.
Customer: So does that mean I have to call the doctor?
Me: No, we’ve already contacted the doctor, but if you want to talk to him to speed things up, that’s your decision.
Customer: Can’t you just tell me the price and I pay it here?
Me: I physically can’t process the prescription here, this is a register computer, it only does what’s filled as of right now.
(We go back and forth like this about PAs, price quotes, insurance, at least 2 more times)
Customer: But why do I need a PA for this? I take it all the time!
Me: I don’t know why the insurance company decided to, but possibly your previous PA ran out, and we just have to renew it.
Customer: So do I call the insurance company?
Me: No, the doctor should be fine. Really, it goes through in less than 3 days most of the time.
Customer: This happens all the time! They NEVER fill my PAs!
(Note: I just had to explain to her what a PA was a few minutes ago, so I highly doubt this happens as often as she makes it out to be.)
Me **exasperated and I want out at this point** then you might want to take that up with your insurance company.
(She seems to get what she wanted to hear at that point, we finish checking out her prescriptions, and she goes presumably to yell at the insurance company. The line has gotten long at this point, and the customer behind her, who has heard the whole thing, rolls his eyes and gives me a sympathetic look.)