Are Prior Authorizations Good for Patients?
Prior authorizations are a tool health insurance companies use in the United States to determine if they will cover a prescribed medication, a procedure, or a service.
Prior authorizations often leads to non-medical switching; the changing of medications for patients for reasons not related to the occurrence of side effects or a lack of clinical efficacy or poor adherence.
According to the America’s Health Insurance Plans group the primary goals of these prior authorization programs are to improve the quality, safety, appropriateness, and affordability of medications.1
While that very well may be the intention, there appears to be some unintended consequences of these programs that are negatively affecting both healthcare providers and patients.
1000 physicians surveyed on their views of prior authorizations
In December of 2020, the American Medical Association surveyed 1,000 U.S. physicians about their personal experiences with prior authorizations in their practice.2 The results were astonishing.
Prior authorizations may be harming patients.
- 94% of physicians reported delays in necessary care for their patients who required a prior authorization.
- 79% of healthcare providers agreed that prior authorizations can lead patients to stop taking their medications.
- 30% of physicians reported prior authorizations have led to a serious adverse event in their patient care.
- 21% of physicians have reported patients being hospitalized due to difficulties with prior authorizations.
- 18% of physicians reported a prior authorization has led to a life-threatening event.
- 9% of physicians reported that prior authorizations have led a patient to have permanent bodily damage, congenital anomaly/birth defects, or even death.
Clinical validity of prior authorization is questionable. When asked about what resources the American Health Insurance Plans group uses to determine their prior authorization programs, 98% said they were using peer-reviewed evidence-based studies.1 Surprisingly, in the American Medical Association survey, 32% of healthcare providers felt that the prior authorization criteria were rarely or never evidence-based.2
Prior Authorizations take a lot of time. Prior authorizations take up a lot of time for healthcare providers. This is time that could be better spent talking to patients. On average, physicians and their staff spend about 16 hours per week completing prior authorizations. 40% of physicians surveyed have a dedicated staff member who specifically works on prior authorizations. The burden of prior authorizations on physicians is very real.
Marley Drug offers a way around Prior Authorizations
As a mail-order pharmacy, licensed in nearly all 50 states, we can ship medications across the U.S. There’s one caveat, which is that we don’t accept any insurance for patients out of our home state of North Carolina.
But that’s not necessarily a bad thing. No insurance means no prior authorization, so no insurance headaches. No insurance also means fewer middle-men like PBMs that add in fees that drive the price of your medications up.
Our pricing model is simple. We price our medications based on what it costs us as the pharmacy to buy. That way you can ensure you’re getting the best cash price for your medications.
Even if you have insurance, we may be a better option; even for generics! According to the KFF 2020 Employee Health Benefits Annual Survey, patients pay an average co-pay of $10 per month for their generic medications.3
Marley Drug's Wholesale Price List offers 45+ commonly prescribed medications for just $5.83 per month if you buy a 1-year supply ($70/year).
Whether you’ve lost insurance or are tired of expensive co-pays, check out our Wholesale Price List where you may realize significant cost savings.
We now offer a branded statin, pitavastatin, at low cash price to bypass prior authorizations. At Marley Drug we know all too well the problems associated with prior authorizations. In December 2020, we started to carry a statin called Zypitamag (pitavastatin). Typically, pitavastatin, as a branded statin, requires a prior authorization to be covered by insurance. Patients typically have to fail on 2 statins in order to get approval for pitavastatin. Currently pitavastatin is available as both Livalo® (pitavastatin calcium) and Zypitamag (pitavastatin magnesium) in the U.S.
We recognized as a pharmacy that this statin was being underutilized because of the many insurance hoops that health insurance companies were putting in place to create a barrier to patient access. Taking a statin, a commonly prescribed medication, to manage your cholesterol shouldn’t require so many hurdles, so we decided to change that.
Through Marley Drug we are now offering exclusive pricing on branded pitavastatin for just $1 a day*. This pricing is available to nearly all patients and bypasses insurance companies altogether. This means no prior authorizations are required and patients can get pitavastatin without having to check a bunch of boxes set out by health insurance companies.
- AHIP Key Results of Industry Survey on Prior Authorization available at: http://www.ahip.org/wp-content/uploads/Prior-Authorization-Survey-Results.pdf
- 2020 AMA prior authorization (PA) physician survey available at: https://www.ama-assn.org/system/files/2021-04/prior-authorization-survey.pdf
- 2020 KFF Employer Health Benefit Survey available at: https://www.kff.org/health-costs/report/2020-employer-health-benefits-survey