Lame Prior Authorization: Express Scripts

I have heard some lame questions for prior authorization of drugs, but Express Scripts reached a new low recently in a review of reimbursement for buprenorphine maintenance for a patient taking the drug for over 6 months. After the routine questions to establish the identities of myself and the patient we got to the serious medical questions:

  • Has the patient paid out of pocket for the drug?

    • Is a physician now supposed to know when a patient pays out of pocket for their prescription?

    • Ask the patient?

  • Will the patient use other opioids with Suboxone?

    • Hang on while I consult my crystal ball.

    • According to the American Psychiatric Association psychiatrists cannot predict the future.

Maybe she was just testing me.

In any case the reviewer approved reimbursement for another year. I wonder what kinds of answers would have led to a denial?

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