Brovana

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Pharmacy Kid

Pharmacy Kid

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Pulmologist prescribed brovana. Called her and essentially had her substitute something else since it's non-form. She asked me to tell the pt that brovana reps were trying to work with pt to get him started on it. I looked up the price with my supervisor and it's about $300-$400 for a month.

That's when I immediately thought, "You just got caught hook, line, and sinker by the reps."
 
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What did you substitute? Isnt there a niche for Brovana?
 
can someone aware me on brovana?
 
nebulized long-acting beta-agonist.

I've only prescribed Brovana once. It was for a patient I saw, self-referred from her PCP. The patient couldn't tolerate foradil or serevent (and has symptomatic COPD). Her reactions were bad enough that she never wanted to try them again (Advair/Symbicort was a non-starter now since she didn't tolerate the above, and was not interested). But she wanted something to help her. She was already on other medications for her COPD.

In addition to non-pharmaceutical treatments that I suggested, I mentioned Brovana. I told her that her insurance will likely not cover it and she will likely have to pay out of pocket. She wanted to try it.

I wrote for it. Pharmacist called me an hour later saying insurance require prior auth. I filled out the paperwork (expecting it to be denied, but that's what I told the patient) - it was denied (with a phone number for appeal). Called the phone number (I had a cancellation so had time) ... and 1 hr later, surprisingly, had it authorized.

She actually got relief with it. And her side effects were minimal. But that's n=1 (and I loathe to write for it again given the trouble I had to go through to get it approved)
 
group_theory said:
nebulized long-acting beta-agonist.

I've only prescribed Brovana once. It was for a patient I saw, self-referred from her PCP. The patient couldn't tolerate foradil or serevent (and has symptomatic COPD). Her reactions were bad enough that she never wanted to try them again (Advair/Symbicort was a non-starter now since she didn't tolerate the above, and was not interested). But she wanted something to help her. She was already on other medications for her COPD.

In addition to non-pharmaceutical treatments that I suggested, I mentioned Brovana. I told her that her insurance will likely not cover it and she will likely have to pay out of pocket. She wanted to try it.

I wrote for it. Pharmacist called me an hour later saying insurance require prior auth. I filled out the paperwork (expecting it to be denied, but that's what I told the patient) - it was denied (with a phone number for appeal). Called the phone number (I had a cancellation so had time) ... and 1 hr later, surprisingly, had it authorized.

She actually got relief with it. And her side effects were minimal. But that's n=1 (and I loathe to write for it again given the trouble I had to go through to get it approved)
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Very informative! Thank you 🙂
 
What does a physician generally have to do to resolve a prior authorization? Fill out a generic form? Is it standardized, or does each insurance company require something different? I have to explain what a prior auth is to about 25 patients per day, so the better I can explain it, maybe the less complaining I will hear in return. About half of our patients interpret a prior auth required as an attempt by the pharmacy to ruin their life. The other half blame the government or mention socialism.
 
tablet said:
About half of our patients interpret a prior auth required as an attempt by the pharmacy to ruin their life. The other half blame the government or mention socialism.
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Lol. It might be different for different drugs whether it's a step therapy prior auth or quantity limit or something else. I approved or denied PAs for awhile and we had to turn them around within 48 hrs, but I think our average was much, much less. So I don't know where they seem to get stuck, doctor's office or insurance company.

Unfortunately, even a reasonable explanation will likely not result in a reasonable reaction. I do see pa's as a necessary evil. The clinic where I am now has designated staff for completing the forms.
 
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Thanks.
I agree with you that it is a necessary evil.
Designated staff means that it creates jobs. That's good.
I spend about 15 minutes with insurance issues for every 1 minute of patient counseling. It sucks the life out of me.
 
Brovana seems like some sort of heaven or nirvana-like state for skiers or frat guys.
 
tablet said:
What does a physician generally have to do to resolve a prior authorization? Fill out a generic form? Is it standardized, or does each insurance company require something different? I have to explain what a prior auth is to about 25 patients per day, so the better I can explain it, maybe the less complaining I will hear in return. About half of our patients interpret a prior auth required as an attempt by the pharmacy to ruin their life. The other half blame the government or mention socialism.
Click to expand...

The physician has to demonstrate why the drug is medically necessary, and (in some cases) attest that tried and failed therapeutic equivalents were not effective (step therapy).

PA forms are not standardized. Each insurance company has their own format, but the questions are usually along similar lines.

Most pharmacies have the PA forms on file, but you can find most of them on the specific payer's website. Fax to the physician. Then it's his/her problem to get it approved, not yours.
 
I don't know of any pharmacy which keeps non-Medicaid PA forms on file. The only reason why we have those is that in Wisconsin almost all PAs for medicaid are sent to the pharmacy to be phoned in for approval. It is the prescriber's responsibility to get the correct form.
 
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