Any Prior Auth Pharmacist out there?

[ericn2k3]

Hi, are you a Prior Auth pharmacist? Can you describe a typical day on the job? Thanks in advance.

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[Sparda29]

Hi, are you a Prior Auth pharmacist? Can you describe a typical day on the job? Thanks in advance.

I'm not a PA pharmacist but I have one calling me every month trying to convince me to stop filling my Pennsaid and Duexis prescriptions.

 

[297point1]

I've done this - I did it right out of pharmacy school in a start-up PBM. This was 20+ years ago, and the company still exists (and is thriving). My role was threefold- (#1) to handle the prior authorization calls coming in from pharmacists and physicians, (#2) handle calls from pharmacies who were having trouble processing claims, and (#3) developing monographs for the P&T committee. Most of the workday was a mix of #1 and #2.

The verbal abuse I received over the telephone was significant; while I was moving as quickly as I could, wait times on the call line were long, and when the caller finally got through to me it felt like I was waiving a red flag at a bull - in many instances the caller absolutely unloaded (with psychiatrists and independent pharmacists the worst offenders). They were never satisfied with merely getting the PA approved - they felt the need to get on their soapbox and rattle off grievances about the length of the wait time, the PA criteria, the need for PAs at all, and the reimbursement rate they were receiving for filling the script. I tried not to take it personally, but I failed. In the six months I worked there:

• I gained 12 pounds (which made me heavier than I've ever been, before or since)
• I drank more than I ever had (before or since)
• My hair began to fall out
• My skin broke out so badly I needed to see a dermatologist
• I began to speak in a flat monotone (to try to calm the callers down), but I started speaking that way all of the time- both inside and outside of work.

This PBM was a regional one at first. One of the worst things was that I was pretty good at this job, so the frequent callers would seek me out because they felt I could help them better than the three other PA pharmacists I was working with- if they got one of the other PA pharmacists on the phone, they'd [politely!] ask to transfer their call to me. I began to recognize callers by name or employer, and knew some calls were going to be trouble within the first five seconds. I took perverse joy when I saw one of my frequent callers on the 6 o'clock news getting busted for filling fraudulent oxycodone scripts a few years later.

I'd finish up a call, and dread the blinking light on the phone indicating that I had another one waiting for me. I'd hit the button to take the call, and hoped for the best; the "best" being a call where I wasn't berated.

So NO - I don't recommend this line of work, despite how appealing a desk job might appear to be. In community pharmacy, you have a somewhat decent chance of having a neutral interaction - or even a positive interaction - with most customers. Pharmacists taking PA phone calls don't have that somewhat decent chance- you are going to deal nonstop with people who would rather not be talking to you. Many will be cranky. Some will be verbally abusive. And the calls never stop.

Perhaps folks with more recent experience as a prior authorization pharmacist have had different experiences than I did. It wasn't worth it for me.

 

[Chrish]

I've done this - I did it right out of pharmacy school in a start-up PBM. This was 20+ years ago, and the company still exists (and is thriving). My role was threefold- (#1) to handle the prior authorization calls coming in from pharmacists and physicians, (#2) handle calls from pharmacies who were having trouble processing claims, and (#3) developing monographs for the P&T committee. Most of the workday was a mix of #1 and #2.

The verbal abuse I received over the telephone was significant; while I was moving as quickly as I could, wait times on the call line were long, and when the caller finally got through to me it felt like I was waiving a red flag at a bull - in many instances the caller absolutely unloaded (with psychiatrists and independent pharmacists the worst offenders). They were never satisfied with merely getting the PA approved - they felt the need to get on their soapbox and rattle off grievances about the length of the wait time, the PA criteria, the need for PAs at all, and the reimbursement rate they were receiving for filling the script. I tried not to take it personally, but I failed. In the six months I worked there:

• I gained 12 pounds (which made me heavier than I've ever been, before or since)
• I drank more than I ever had (before or since)
• My hair began to fall out
• My skin broke out so badly I needed to see a dermatologist
• I began to speak in a flat monotone (to try to calm the callers down), but I started speaking that way all of the time- both inside and outside of work.

This PBM was a regional one at first. One of the worst things was that I was pretty good at this job, so the frequent callers would seek me out because they felt I could help them better than the three other PA pharmacists I was working with- if they got one of the other PA pharmacists on the phone, they'd [politely!] ask to transfer their call to me. I began to recognize callers by name or employer, and knew some calls were going to be trouble within the first five seconds. I took perverse joy when I saw one of my frequent callers on the 6 o'clock news getting busted for filling fraudulent oxycodone scripts a few years later.

I'd finish up a call, and dread the blinking light on the phone indicating that I had another one waiting for me. I'd hit the button to take the call, and hoped for the best; the "best" being a call where I wasn't berated.

So NO - I don't recommend this line of work, despite how appealing a desk job might appear to be. In community pharmacy, you have a somewhat decent chance of having a neutral interaction - or even a positive interaction - with most customers. Pharmacists taking PA phone calls don't have that somewhat decent chance- you are going to deal nonstop with people who would rather not be talking to you. Many will be cranky. Some will be verbally abusive. And the calls never stop.

Perhaps folks with more recent experience as a prior authorization pharmacist have had different experiences than I did. It wasn't worth it for me.

Can't you just deny/ accept PA and then tell them to have a nice day? Just cut the conversation short by telling them about the final outcome and if they get cranky, just pretend to listen to them for a minute and then say if there isn't anything else, then have a nice day.

I see this in retail all the time where rph/ techs let the customers ramble for minutes when the phone call can be taken care of in 10 seconds.

 

[297point1]

Can't you just deny/ accept PA and then tell them to have a nice day? Just cut the conversation short by telling them about the final outcome and if they get cranky, just pretend to listen to them for a minute and then say if there isn't anything else, then have a nice day.

I see this in retail all the time where rph/ techs let the customers ramble for minutes when the phone call can be taken care of in 10 seconds.

Fair point. I was pretty good at getting them off the phone once the issue was resolved. Getting them to 'get to their point' was the bigger challenge. And "this call is being monitored for quality assurance purposes" forced me to be way more polite than some callers deserved.

 

[Chrish]

Fair point. I was pretty good at getting them off the phone once the issue was resolved. Getting them to 'get to their point' was the bigger challenge. And "this call is being monitored for quality assurance purposes" forced me to be way more polite than some callers deserved.

I mean it's our job to get people to come to the point. We are the driver. For example when I pick up the phone, I promptly ask them what's the name and birthday and once I pull up the profile, I ask them if they need a refill or just checking on the status of their script? Basically I direct the whole conversation. I don't let them talk about how they started having panic attack yesterday at 3 am and then went to emergency room at 6 am and waited to see Dr. Chang for 6 hours and how Dr. Chang was supposed to send something in. I neither care nor need to know these details to resolve their issue.

 

[Sparda29]

I've done this - I did it right out of pharmacy school in a start-up PBM. This was 20+ years ago, and the company still exists (and is thriving). My role was threefold- (#1) to handle the prior authorization calls coming in from pharmacists and physicians, (#2) handle calls from pharmacies who were having trouble processing claims, and (#3) developing monographs for the P&T committee. Most of the workday was a mix of #1 and #2.

The verbal abuse I received over the telephone was significant; while I was moving as quickly as I could, wait times on the call line were long, and when the caller finally got through to me it felt like I was waiving a red flag at a bull - in many instances the caller absolutely unloaded (with psychiatrists and independent pharmacists the worst offenders). They were never satisfied with merely getting the PA approved - they felt the need to get on their soapbox and rattle off grievances about the length of the wait time, the PA criteria, the need for PAs at all, and the reimbursement rate they were receiving for filling the script. I tried not to take it personally, but I failed. In the six months I worked there:

• I gained 12 pounds (which made me heavier than I've ever been, before or since)
• I drank more than I ever had (before or since)
• My hair began to fall out
• My skin broke out so badly I needed to see a dermatologist
• I began to speak in a flat monotone (to try to calm the callers down), but I started speaking that way all of the time- both inside and outside of work.

This PBM was a regional one at first. One of the worst things was that I was pretty good at this job, so the frequent callers would seek me out because they felt I could help them better than the three other PA pharmacists I was working with- if they got one of the other PA pharmacists on the phone, they'd [politely!] ask to transfer their call to me. I began to recognize callers by name or employer, and knew some calls were going to be trouble within the first five seconds. I took perverse joy when I saw one of my frequent callers on the 6 o'clock news getting busted for filling fraudulent oxycodone scripts a few years later.

I'd finish up a call, and dread the blinking light on the phone indicating that I had another one waiting for me. I'd hit the button to take the call, and hoped for the best; the "best" being a call where I wasn't berated.

So NO - I don't recommend this line of work, despite how appealing a desk job might appear to be. In community pharmacy, you have a somewhat decent chance of having a neutral interaction - or even a positive interaction - with most customers. Pharmacists taking PA phone calls don't have that somewhat decent chance- you are going to deal nonstop with people who would rather not be talking to you. Many will be cranky. Some will be verbally abusive. And the calls never stop.

Perhaps folks with more recent experience as a prior authorization pharmacist have had different experiences than I did. It wasn't worth it for me.

Do you blame them though? Your company made pharmacists jobs harder and is not good for patients simply to preserve a profit for the PBM.

Hopefully, PBMs get outlawed soon.

 

[WVUPharm2007]

I've done this - I did it right out of pharmacy school in a start-up PBM. This was 20+ years ago, and the company still exists (and is thriving). My role was threefold- (#1) to handle the prior authorization calls coming in from pharmacists and physicians, (#2) handle calls from pharmacies who were having trouble processing claims, and (#3) developing monographs for the P&T committee. Most of the workday was a mix of #1 and #2.

The verbal abuse I received over the telephone was significant; while I was moving as quickly as I could, wait times on the call line were long, and when the caller finally got through to me it felt like I was waiving a red flag at a bull - in many instances the caller absolutely unloaded (with psychiatrists and independent pharmacists the worst offenders). They were never satisfied with merely getting the PA approved - they felt the need to get on their soapbox and rattle off grievances about the length of the wait time, the PA criteria, the need for PAs at all, and the reimbursement rate they were receiving for filling the script. I tried not to take it personally, but I failed. In the six months I worked there:

• I gained 12 pounds (which made me heavier than I've ever been, before or since)
• I drank more than I ever had (before or since)
• My hair began to fall out
• My skin broke out so badly I needed to see a dermatologist
• I began to speak in a flat monotone (to try to calm the callers down), but I started speaking that way all of the time- both inside and outside of work.

This PBM was a regional one at first. One of the worst things was that I was pretty good at this job, so the frequent callers would seek me out because they felt I could help them better than the three other PA pharmacists I was working with- if they got one of the other PA pharmacists on the phone, they'd [politely!] ask to transfer their call to me. I began to recognize callers by name or employer, and knew some calls were going to be trouble within the first five seconds. I took perverse joy when I saw one of my frequent callers on the 6 o'clock news getting busted for filling fraudulent oxycodone scripts a few years later.

I'd finish up a call, and dread the blinking light on the phone indicating that I had another one waiting for me. I'd hit the button to take the call, and hoped for the best; the "best" being a call where I wasn't berated.

So NO - I don't recommend this line of work, despite how appealing a desk job might appear to be. In community pharmacy, you have a somewhat decent chance of having a neutral interaction - or even a positive interaction - with most customers. Pharmacists taking PA phone calls don't have that somewhat decent chance- you are going to deal nonstop with people who would rather not be talking to you. Many will be cranky. Some will be verbally abusive. And the calls never stop.

Perhaps folks with more recent experience as a prior authorization pharmacist have had different experiences than I did. It wasn't worth it for me.

The job revolves around telling people that they can't have the drug therapy their doctor wants them to take. WTF do you expect?

 

[Sine Cura]

If there weren't minimal criteria you'd have more dip**** emergency dept PAs writing olanzapine for 5-year-olds.

 

[WVUPharm2007]

If there weren't minimal criteria you'd have more dip**** emergency dept PAs writing olanzapine for 5-year-olds.

Sure. Does the general public give a single damn? No.

 

[Sparda29]

If there weren't minimal criteria you'd have more dip**** emergency dept PAs writing olanzapine for 5-year-olds.

DUR rejects are there for safety.

PAs exist solely to preserve PBM/insurance profit and to minimize pharmacy stores profit.

 

[PikminOC]

It's such a waste of time. Many pp Psychiatrist are not on salary so their time is not paid for.