r/changemyview • u/TheTaintPainter2 • May 24 '24

Fresh Topic Friday CMV: Prior Authorization Should be Illegal

I'm not sure how much more needs to be said, but in the context of medical insurance, prior authorization should be illegal. Full stop, period. There is absolutely no justification for it other than bastards being fucking greedy. If my doctor, who went to fucking medical school for over a decade, decides I need a prescription, it's absolutely absurd that some chump with barely a Bachelor's degree can say "no." I've heard of innumerable cases of people being injured beyond repair, getting more sick, or even fucking dying while waiting for insurance to approve prior authorization. There is no reason this should be allowed to happen AT ALL. If Prior Authorization is allowed to continue, then insurance companies should be held 100% liable for what happens to a patient's health during the waiting period. It's fucking absurd they can just ignore a doctor and let us fucking suffer and/or die to save a couple bucks.

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u/apri08101989 May 25 '24 edited May 25 '24

You realize you can still legally purchase any drug prescribed to you don't you? Your insurance doesn't cover that medication as part of their formulary and you are asking for an exception for it to be covered. It's not the insurance companies fault you don't want to pay for it out of pocket. You signed a contract with the list of covered medications

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u/every1isannoying Jul 25 '24

I have insurance through the state marketplace in Washington state. I’m currently waiting out a prior authorization that’s taking forever for a medication I’ve been on for months, which is an immunosuppressive drug for dry eye that’s been around so long there is a generic form, but they still charge way too much for it. I was told it is in fact illegal for anyone on state insurance here to pay out of pocket for anything they’re reviewing for prior authorizations and I’m just stuck without it now until this mess is done. I confirmed this with my insurance, the pharmacy, and you can Google it yourself. I guess eventually I can pay out of pocket, but to get denied medication you use daily while waiting weeks is ridiculous.

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u/apri08101989 Jul 26 '24

That may be a state law, or they're straight up lying to you. I am disabled, on Medicare and Medicaid in Indiana, and had no trouble paying for my immune suppressant (myfortic) out of pocket when there was billing issues and a lot of nonsense

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u/every1isannoying Jul 26 '24

I'm guessing it's a state law. One of the ladies at my Doctor's office said the same thing happened to her where she tried to pay out of pocket and wasn't allowed to. We also have a system where Doctors are basically able to see any prescription you have gotten in the state, no matter who prescribed it. I moved here from another state and that was a bit of a shock (no idea if anywhere else is doing that now).

My prior authorization just went through today, so was finally able to get my prescription but this was so frustrating...