This has officially crossed from frustrating into absurd. This is a photo of the instruction booklet we had to assemble for our team. We employ a full-time staff member whose entire job is medication prior authorizations. We now have recruited MAs and support staff. She works 40+ hours a week and is still a month behind. Her days are spent on endless hold with insurers and pharmacies, arguing with equally burned-out reps, and absorbing the anger of patients who just want their meds. I genuinely don’t know how she does it.
The photo below shows just some of the prior-auth requirements for just some of the medications we prescribe.
Here’s the part patients don’t see:
They call their insurer and are told, “Yes, the medication is covered.”
Then comes the catch: “Your clinician just needs to complete a prior authorization.”
We do it. The medication is denied. Patients ask for appeals.
9.9 out of 10 appeals are denied. And guess who patients are angry with?
Not the payer. Not the PBM.
Us.
Physicians and staff are stuck as the middlemen in a system designed to delay care, exhaust clinicians, and quietly ration medications under the guise of “coverage.”
I’m about to send a message to our entire practice explaining this reality because the moral injury and burnout are real, and they’re accelerating.
Something has to give.
This is not sustainable.
Mark Cuban Preston Alexander Graham Walker, MD tagging for amplification
The photo below shows just some of the prior-auth requirements for just some of the medications we prescribe.
Here’s the part patients don’t see:
They call their insurer and are told, “Yes, the medication is covered.”
Then comes the catch: “Your clinician just needs to complete a prior authorization.”
We do it. The medication is denied. Patients ask for appeals.
9.9 out of 10 appeals are denied. And guess who patients are angry with?
Not the payer. Not the PBM.
Us.
Physicians and staff are stuck as the middlemen in a system designed to delay care, exhaust clinicians, and quietly ration medications under the guise of “coverage.”
I’m about to send a message to our entire practice explaining this reality because the moral injury and burnout are real, and they’re accelerating.
Something has to give.
This is not sustainable.
Mark Cuban Preston Alexander Graham Walker, MD tagging for amplification
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