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Envision This

EnvisionRx’s stupid questions got stupid answers, but their reviewers wisely approved the prescription anyway.

In last week’s post I gave EnvisionRx some free advice on how (not?) to craft a drug prior authorization form. Herein I will show you the responses that got the approval. Or did a phone call from an angry subscriber do the trick?

  • "Have other formulary alternatives in this drug category/class been tried and failed?"
    • I checked “No.” (There was no box for “I don’t know.”)
  • "Please list them below along with the date the medication was tried and failed."
    • “No access to your formulary or prior prescribers’ records.”
  • "If the patient is unable to tolerate the formulary alternative, what is the issue the patient is having?"
    • “Patient is not ‘having’ any ‘issues.’
  • "For medical necessity reviews, you must provide a unique peer-reviewed journal article to support your request for off-label use, Please attach any medical information that may support approval."
    • “I’m not your gopher.”
  • "Please provide any supporting clinical statements (such as lab values, adverse outcomes, treatment failures, or any other additional clinical information to support a formulary exception request)"
    • I left this one blank.

I provided essentially none of the information EnvisionRx so hamfistedly requested (other than a diagnosis), yet they approved reimbursement.

I hope other prescribers will take this approach and encourage insurance plan subscribers to express their anger directly to the functionaries who implement this wasteful procedure. It just might work.

Remember, the prescriber must only (unless you contract with the payer) provide a copy of the medical record. The prescriber has no obligation to obtain money for the patient to buy the drug.

"For to a folysshe demaunde behoueth a folysshe ansuere." - William Caxton

"Ask a silly question, and you'll get a silly answer." - Mom


 

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