Doing too much (prior authorizations)

[DocEspana]

This may very well be a very quick thread that few people answered the exact same way and that we can just let die, but in case somehow it ends up lingering around, let me give it an actual purpose and topic.

I started at a new job about 2 to 3 months ago. Incredibly high-end hospital system that cares tremendously about the customer experience. One of the things I picked up right away is that they mostly hire new graduates in the emergency department, and the director is not afraid to say that part of that is so he can make sure he teaches them the culture off the bat. It sounds like a recipe for malignancy but he's actually a super chill and nice guy generally, just asks that you make sure the customer experience is good rather than focusing on any specific asinine metric.

Almost a decade into being an attending, suddenly I'm dealing with something that I thought was simply not a part of the emergency medicine world. I'm receiving two to three prior authorization requests. Every single shift for prescriptions that I've sent. The prior authorizations come directly to my personal email because the hospital has linked any faxes that come with my name on it to my email.

Do I even do with these? Are other people doing these? I'm more of the knife and gun club. Kind of guy, but this is my long-term retirement plan, to get into a really benign place that just cares about doing good medicine and just coast now that the big debts are paid off. So maybe this is something people in fancy hospitals do? I've asked around at my job and a few people say they ignore them but most people are grumbling and saying that it's the worst part of the job there. The fact that most of these people have worked there for their entire attending career does make me think that a few of them don't realize that it's not normal to do these. NOBODY has actually said the boss specifically wants them to do it, but many of them assume he must. And I'm hesitant to ask him because if he says yes then I lose plausible deniability about ignoring them.

Besides answering my question as to what to do about these prior authorization requests - this could theoretically be a thread about s*** that only happens in customer service focused emergency departments as opposed to "don't let the crackhead steal medical supplies" emergency departments.

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[VA Hopeful Dr]

Not EM, but as an FP these things are part of my daily existence...

Don't do them. Odds are you won't be able to get them approved anyone since it requires a bit of history of answer them in such a way that would work.

Find out what meds are causing them and stop writing those meds. I'd wager a lot of them are coming from lidocaine patches. Also flexeril for old people.

 

[gruemd]

Any time I get one of those it goes straight in the bin. Then again, we have an archaic fax system here and nobody has my person email address (thank goodness) so I maintain plausible deniability.

 

[emergentmd]

We are ER docs. Once they are out of the ED, they are not my patient. No refills, no return to work, no occ health paperwork.

I am like a ghost after they leave the ED.

 

[JacobMcCandles]

Ignore. Stuff like this is how the frog gets boiled. At some point you’ve got to say no and stick to your guns.

 

[dozitgetchahi]

This may very well be a very quick thread that few people answered the exact same way and that we can just let die, but in case somehow it ends up lingering around, let me give it an actual purpose and topic.

I started at a new job about 2 to 3 months ago. Incredibly high-end hospital system that cares tremendously about the customer experience. One of the things I picked up right away is that they mostly hire new graduates in the emergency department, and the director is not afraid to say that part of that is so he can make sure he teaches them the culture off the bat. It sounds like a recipe for malignancy but he's actually a super chill and nice guy generally, just asks that you make sure the customer experience is good rather than focusing on any specific asinine metric.

Almost a decade into being an attending, suddenly I'm dealing with something that I thought was simply not a part of the emergency medicine world. I'm receiving two to three prior authorization requests. Every single shift for prescriptions that I've sent. The prior authorizations come directly to my personal email because the hospital has linked any faxes that come with my name on it to my email.

Do I even do with these? Are other people doing these? I'm more of the knife and gun club. Kind of guy, but this is my long-term retirement plan, to get into a really benign place that just cares about doing good medicine and just coast now that the big debts are paid off. So maybe this is something people in fancy hospitals do? I've asked around at my job and a few people say they ignore them but most people are grumbling and saying that it's the worst part of the job there. The fact that most of these people have worked there for their entire attending career does make me think that a few of them don't realize that it's not normal to do these. NOBODY has actually said the boss specifically wants them to do it, but many of them assume he must. And I'm hesitant to ask him because if he says yes then I lose plausible deniability about ignoring them.

Besides answering my question as to what to do about these prior authorization requests - this could theoretically be a thread about s*** that only happens in customer service focused emergency departments as opposed to "don't let the crackhead steal medical supplies" emergency departments.

I’m rheumatology, but I chuckled as I read the description of the culture at this institution… because it sounds almost exactly like the culture at the bougie institution where I did rheumatology fellowship:

- Weird, almost obsessive focus on patient satisfaction
- Attendings who had been there their whole careers, and who did not realize that the institutional culture was messed up/that they were doing a ton of scut work that nobody elsewhere does
- The institutional culture is to take all of this weirdness quietly, and not push back at all.

I don’t personally do prior auths as an outpatient rheum - staff does 99% of them. I’d never touch any of them if I worked in the ER. That said, I’d look closely at what you’re prescribing and try to avoid writing scripts that may lead to a prior auth.

 

[emergentmd]

We went into EM because we wanted to be a ghost once pts leave the ER.

Ask yourself what would a ghost do? 🙂

 

[RustedFox]

Duude, be careful.
This is exactly the type of place that burnt me to a crisp in 2020 and made me want to walk long into the woods and not walk out.

 

[DocEspana]

Duude, be careful.
This is exactly the type of place that burnt me to a crisp in 2020 and made me want to walk long into the woods and not walk out.

Thankfully it has absurd MD/PA staffing, free* scribes, and it's the first place I've ever seen without nursing shortages in the ED and where nurses don't get flexed if it gets slow. So yeah I'm doing stupid customer service stuff but also when they say "see 1.5 patients per hour", you're going to have to fight other people to accomplish that because thats the actual staffing most days once the total volume is divided by hours. Everyone drinking the Kool aid says the same thing, that they're there to just see patients at a chill pace and get the check.

But then you get an email that's just not EM culture like "please remember. If there is an issue with an opiate rx your partner wrote, don't make the patient wait for them to come back to work. Just fix it or send it somewhere else for them." There's nothing overtly wrong with it but also - that flies in the face of everything every other ER does.

*Nothing is free. I'm sure the pay could be $20 an hour higher if the scribes didn't exist.

 

[GassYous]

We went into EM because we wanted to be a ghost once pts leave the ER.

Ask yourself what would a ghost do? 🙂

Well it depends. Are we talking Casper the friendly ghost or Poltergeist ghost? Patrick Swayze ghost is a whole different level.

 

[RustedFox]

Thankfully it has absurd MD/PA staffing, free* scribes, and it's the first place I've ever seen without nursing shortages in the ED and where nurses don't get flexed if it gets slow. So yeah I'm doing stupid customer service stuff but also when they say "see 1.5 patients per hour", you're going to have to fight other people to accomplish that because thats the actual staffing most days once the total volume is divided by hours. Everyone drinking the Kool aid says the same thing, that they're there to just see patients at a chill pace and get the check.

But then you get an email that's just not EM culture like "please remember. If there is an issue with an opiate rx your partner wrote, don't make the patient wait for them to come back to work. Just fix it or send it somewhere else for them." There's nothing overtly wrong with it but also - that flies in the face of everything every other ER does.

*Nothing is free. I'm sure the pay could be $20 an hour higher if the scribes didn't exist.

It was a mix of Insufferable patients and admin just crawling all over each other telling us to kiss patient ass that was the poison.

 

[TooMuchResearch]

Thankfully it has absurd MD/PA staffing, free* scribes, and it's the first place I've ever seen without nursing shortages in the ED and where nurses don't get flexed if it gets slow. So yeah I'm doing stupid customer service stuff but also when they say "see 1.5 patients per hour", you're going to have to fight other people to accomplish that because thats the actual staffing most days once the total volume is divided by hours. Everyone drinking the Kool aid says the same thing, that they're there to just see patients at a chill pace and get the check.

But then you get an email that's just not EM culture like "please remember. If there is an issue with an opiate rx your partner wrote, don't make the patient wait for them to come back to work. Just fix it or send it somewhere else for them." There's nothing overtly wrong with it but also - that flies in the face of everything every other ER does.

*Nothing is free. I'm sure the pay could be $20 an hour higher if the scribes didn't exist.

Wait is it not standard to fix other people's prescriptions if there is an issue? We do that routinely.

 

[Groove]

I don't think I've ever been sent or requested to fill out a prior authorization form. Definitely not the norm and my current gig is at an affluent community hospital.

 

[DocEspana]

Wait is it not standard to fix other people's prescriptions if there is an issue? We do that routinely.

Opiate prescriptions? Everywhere I've worked people have just chuckled at the mere suggestion that a doctor who didn't see you would either fix an error on the rx or reroute to a different pharmacy. It seemed like such a uniform thing that nurses would just tell people at triage to come back when the original prescriber was working because no one is going to resend an opiate rx for them.

Now I'm rewriting sizzurp and Percocets all day. I will admit that the currently new hospital community here has us rewrite *every* prescription all the damn time because they want immediate convenience and it doesn't seem like opiates are requested more than any other medication for rx adjustments. My prior sites you would *never* find someone coming back requesting you send their abx or bp med somewhere else but it was really common to have them come back saying they need their opiates sent elsewhere or resent. The ratio sort of implies there is a difference going on.

 

[pkwraith]

What meds are you running into preauthorization? There should be very few ED meds that needs preauth that there is a cheaper subsitute. I usually gets calls from pharmacy for other docs trying to get fancy with antibiotics like cefopodoxime, and those are pretty substituted pretty easily.
I remember one time trying to get fidoxomicin covered for someone in the ED for refractory c diff that I wanted to keep out of the hospital, but eventually just gave up.

 

[AlmostAnMD]

I see someone else is writing an Andexxa script to go with eliquis starter pack

you never know, right??

 

[Apollyon]

This is over 10 years ago, but, had a day at a mid range ED (not poor, not rich) where I dx'd PE, and tried to Rx Eliquis, to cover until pt could see PMD. First, PMD office, despite being told it's their pt, and needs to be seen for Eliquis, refused to schedule pt, for unknown reasons (not bad pt, they would admit if he needed it). Then, I get a call about a prior auth. I call the PMD office back, and get the prior auth nurse. That's all she does all day. She has the gall to say, "You should have someone there doing it". For something that happens once a year, or less?

Honestly, I don't recall my resolution. But, pt neither died from PE nor bled to death.

 

[RustedFox]

I see someone else is writing an Andexxa script to go with eliquis starter pack

you never know, right??

That's not a thing.

 

[AlmostAnMD]

That's not a thing.

Only I can ruin my own bad jokes sir

 

[Birdstrike]

You should never EVER have to do prior auths in the ED. Nothing says “Not an emergency, not even close” like require a doctor to step out of patient care and argue with an insurance clearly and fill out paperwork.

If this is being required in EM, EM has degenerated beyond how and I could ever imagine it could degenerate to. True
decay.

Prior auths for meds and procedures are the bane of the outpatient doctor’s existence. It falls on one of my two nurses to do the rare med prior with needed for my patients, and that’s only for people I made the mistake of prescribing expensive brand name stuff to, ten years ago and we’re stuck refilling. For procedure prior auths, we employ a whole department to play this insulting, wasteful game invented by insurance swindlers. We only do this, because it’s the only way we can get paid for what we do.

Once you agree to do these you’ll never stop. You’ll spend hours on the phone with some college dropout arguing and filling out gobs of paper work. Then it’ll get denied. “Okay, must appeal.”

Action plan:

-Stop prescribing the fancy new crap you see on TV commercials. Most of this stuff isn’t as good as initial pharma sponsored research claims it is. You’ve been lied to, more often than not by pharma.

-Go back to prescribing drugs that have are generic or tried and true.

-If any patient or anyone else gets pissed off, remind them its their insurance company, they picked and pay for, that won’t pay for their meds. They have to option to pay cash for the fancy stuff and go outside the insurance company. They can call the insurance company and scream at them and complain. And what always happens, the insurance clerk pullls out a script that tells them to blame the doctor, “He only has to sign a form” “The doctors office is refusing to help you.” “We at the insurance company want you to have the medicine and have made this process as easy as possible. The doctor is being unreasonable.” All unethical, purposeful lies written by greedy, insurance executives who profit the more care and medicine they deny their customers. As if you have the time to spend on an automate customer service recording for hours, on all 4,000 patients you see each year.

-And you have the right not to prescribe crap that defaults you from physician to a high school degreed clerk.

-But if you insist on playing the insurance company’s gaslight game, prescribing the stuff on commercials backed up by often skewed pharma funded and biased research, then you’re going to be stuck dealing with being their pawn or paying someone to do it.

 

[Janders]

We get prior auths faxed to us. They go in the shredder.

The key is to look and see if there is something in your prescribing pattern that is causing these. No lidoderm Rx, tell the patient to but 4% OTC lidocaine patches. Careful with fancy antibiotics. For DOACs, I just straight up tell the patient this is gonna be expensive, but the alternative involves hospitalization and blood draws out their arse. And recommend they pony up the cash for the first month, and work with their PCP to figure it out going forward.

Now I ABSOLUTELY fix Rx for my partners when patients / pharmacies call back. Our PAs handle most of it. But retail pharmacy is a terrible cluster currently, hours changing, pharmacies closing, refusing to transfer Rx. It’s not fun, but it also takes 1-2 minutes to resend an antibiotic to a new pharmacy and drop a one line note. This includes (rarely) re-doing a controlled Rx. The fun part is we Rx few opiates now, and have robust EMR and PDMP linkages… so if anything i feel SAFER fixing a broken Oxy Rx for a shattered humerus…

 

[Mount Asclepius]

What meds are you running into preauthorization? There should be very few ED meds that needs preauth that there is a cheaper subsitute. I usually gets calls from pharmacy for other docs trying to get fancy with antibiotics like cefopodoxime, and those are pretty substituted pretty easily.
I remember one time trying to get fidoxomicin covered for someone in the ED for refractory c diff that I wanted to keep out of the hospital, but eventually just gave up.

I don’t disagree with your first point. Cefpodoxime for non-septic, outpatient managed pyelonephritis and Fidaxomicin for initial episode, non-fulminant C. Difficile infections are now and have been for sometime our preferred and recommended first line antibiotics. We haven’t been having issues with insurance rejections. Easy to substitute these though as there are alternatives that have been around longer and probably cheaper.

 

[WhatJobDoIPick]

Patient's insurance issues are not my problem.

 

[DocEspana]

What meds are you running into preauthorization? There should be very few ED meds that needs preauth that there is a cheaper subsitute. I usually gets calls from pharmacy for other docs trying to get fancy with antibiotics like cefopodoxime, and those are pretty substituted pretty easily.
I remember one time trying to get fidoxomicin covered for someone in the ED for refractory c diff that I wanted to keep out of the hospital, but eventually just gave up.

honestly LOTS of lidocaine patches (weirdly I only write for 4%, so its OTC anyway), fioricet (local community freaking loves it but its generic anyway), Eliquis/other NOACs (what else am I going to do? Admit that DVT? never), and muscle relaxers of every single variety.

Its not even like this stuff should raise red flags, yet they do. I'm still ignoring them, but was creeped out by the number of indoctrinated people in the group who thought this was just a part of being an attending in EM.

 

[BoardingDoc]

Prior auths go in the shredder. This is not your job. I now do prior auths routinely in pain Med. Let me be abundantly clear: YOU DO NOT WANT TO DO THIS.

I can not stress enough how obnoxious an experience these things are. You are not required to do them as an EM doc. Moreover, getting many of these drugs approved would require you to answer questions about the patient that you likely don't know or can't know without deep diving through their medical records.

 

[RustedFox]

Prior auths...

These things should not exist.

I'm betting DOGE Healthcare would run the numbers and say: "If you just honored your agreement and paid for the meds upfront, you'd save money altogether versus wasting it on the manpower needed to deny it."

 

[DocEspana]

Prior auths...

These things should not exist.

I'm betting DOGE Healthcare would run the numbers and say: "If you just honored your agreement and paid for the meds upfront, you'd save money altogether versus wasting it on the manpower needed to deny it."

Don't try to make me love him, because I don't want to, but that would work

 

[VA Hopeful Dr]

Prior auths...

These things should not exist.

I'm betting DOGE Healthcare would run the numbers and say: "If you just honored your agreement and paid for the meds upfront, you'd save money altogether versus wasting it on the manpower needed to deny it."

If that was true insurance wouldn't require them.

 

[RustedFox]

If that was true insurance wouldn't require them.

I'm not sure this is true anymore.
Everything gets sent to the ER nowadays for instant approval, and it ends up costing what... 3x more?
Forget what I said about meds; just go broad.

 

[dozitgetchahi]

Thankfully it has absurd MD/PA staffing, free* scribes, and it's the first place I've ever seen without nursing shortages in the ED and where nurses don't get flexed if it gets slow. So yeah I'm doing stupid customer service stuff but also when they say "see 1.5 patients per hour", you're going to have to fight other people to accomplish that because thats the actual staffing most days once the total volume is divided by hours. Everyone drinking the Kool aid says the same thing, that they're there to just see patients at a chill pace and get the check.

But then you get an email that's just not EM culture like "please remember. If there is an issue with an opiate rx your partner wrote, don't make the patient wait for them to come back to work. Just fix it or send it somewhere else for them." There's nothing overtly wrong with it but also - that flies in the face of everything every other ER does.

*Nothing is free. I'm sure the pay could be $20 an hour higher if the scribes didn't exist.

Not sure if the opioid script thing is standard practice in EM or what, but I’d never write an opioid script on a patient I haven’t seen personally.

The other rheum in my practice is something of a “candy man” - lots of opioid scripts - whereas I write none whatsoever. I don’t even cover his patients anymore because I refused to write the huge number of controlled substance refill scripts he had in the past.

Why do these scripts need to be changed, anyway? They’re written wrong?

 

[DocEspana]

Not sure if the opioid script thing is standard practice in EM or what, but I’d never write an opioid script on a patient I haven’t seen personally.

The other rheum in my practice is something of a “candy man” - lots of opioid scripts - whereas I write none whatsoever. I don’t even cover his patients anymore because I refused to write the huge number of controlled substance refill scripts he had in the past.

Why do these scripts need to be changed, anyway? They’re written wrong?

Sometimes minor mistakes like missing a clause that's required by Florida law on an opiate.

Sometimes reasonable but not perfect: it's a liquid and the volume is not mathed out right.

Sometimes fishy like pharmacy says they don't have hydrocodone they need you to write oxycodone.

Sometimes a red flag like "I tried to find hycodin everywhere but I can't, so can I just get liquid oxycodone because everyplace says they have that"

Sometimes fully "the pharmacy says they will take too many days to fill this and I need it now but they won't give me the rx back so I need a new Rx to take elsewhere"

All of these I used to ignore but new boss says to just go and do it +/- calling the pharmacy to confirm the details

 

[gutonc]

I'm not sure this is true anymore.
Everything gets sent to the ER nowadays for instant approval, and it ends up costing what... 3x more?
Forget what I said about meds; just go broad.

I tend to agree with you, at least on procedures/imaging/testing. Between prior auth shenanigans and general dysfunction in the healthcare system these days, I'm having to do PAs on anything other than a CT CAP (PET, MRI, etc) and even once I get it approved, it's taking 2-3 months to get them scheduled. I had a guy with met pancreatic cancer and a bili of 7 from obstruction that GI had booked for an ERCP the first week of April (this was 2 weeks ago). I sent him to the ER and he magically got the ERCP next day. At 10x the cost and impacting access for other people. At least the ED doc got an easy one there.

I've spent the past 12 years of my career doing everything I could to keep people out of the hospital unless they absolutely needed to be there. But in the last 3-4 years, sending them to the ED for admission (since direct admits are essentially a thing of the past unless you book it 2-3w ahead of time) has become the only way to get things done. It's a drain on the patients, healthcare finances and all the unnecessary touches needed to get things done.

 

[RustedFox]

I tend to agree with you, at least on procedures/imaging/testing. Between prior auth shenanigans and general dysfunction in the healthcare system these days,

This was more of the tenor that I was going for. Thanks for putting up with my tired brain.

I'm having to do PAs on anything other than a CT CAP (PET, MRI, etc) and even once I get it approved, it's taking 2-3 months to get them scheduled.

Unacceptable. We need to slap these insurers with metrics like we have.

I had a guy with met pancreatic cancer and a bili of 7 from obstruction that GI had booked for an ERCP the first week of April (this was 2 weeks ago). I sent him to the ER and he magically got the ERCP next day. At 10x the cost and impacting access for other people. At least the ED doc got an easy one there.

That wasn't easy, as hearing these complicated words makes many ER docs say: "Uhh, a what?"

I've spent the past 12 years of my career doing everything I could to keep people out of the hospital unless they absolutely needed to be there.

God bless you.

But in the last 3-4 years, sending them to the ED for admission (since direct admits are essentially a thing of the past unless you book it 2-3w ahead of time) has become the only way to get things done. It's a drain on the patients, healthcare finances and all the unnecessary touches needed to get things done.

Enter DOGEHealthcare.

 

[AlmostAnMD]

Unacceptable. We need to slap these insurers with metrics like we have.

I speak to insurance directors frequently. They DO have metrics. Deny.

Keep in mind, the almighty dollar is what all doctors on all sides worship.

Your god is press-ganey. If you had a consistent 1% PG and had numerous complaints for not putting up with BS, you would be fired.

Insurance gods are denials. An insurance director that approves everything is a hero to you but would also call himself unemployed.

Both sides want a job. Both sides have to play the game.

The only way this changes is if the gods change.

 

[RustedFox]

I speak to insurance directors frequently. They DO have metrics. Deny.

Keep in mind, the almighty dollar is what all doctors on all sides worship.

Your god is press-ganey. If you had a consistent 1% PG and had numerous complaints for not putting up with BS, you would be fired.

Insurance gods are denials. An insurance director that approves everything is a hero to you but would also call himself unemployed.

Both sides want a job. Both sides have to play the game.

The only way this changes is if the gods change.

We need to kill the old gods.
It has happened multiple times throughout human history.

The Gods and Goddesses of the ancient Greeks and Romans are now cartoon characters. "Mythology".


What we need is a "fair shake system". If we're paying insane amounts of health insurance (I am), we need to get our money's worth out of it; not pay MORE after their games; and the house wins every time.

 

[gutonc]

That wasn't easy, as hearing these complicated words makes many ER docs say: "Uhh, a what?"

Admit to medicine with GI consult.

 

[TooMuchResearch]

I tend to agree with you, at least on procedures/imaging/testing. Between prior auth shenanigans and general dysfunction in the healthcare system these days, I'm having to do PAs on anything other than a CT CAP (PET, MRI, etc) and even once I get it approved, it's taking 2-3 months to get them scheduled. I had a guy with met pancreatic cancer and a bili of 7 from obstruction that GI had booked for an ERCP the first week of April (this was 2 weeks ago). I sent him to the ER and he magically got the ERCP next day. At 10x the cost and impacting access for other people. At least the ED doc got an easy one there.

I've spent the past 12 years of my career doing everything I could to keep people out of the hospital unless they absolutely needed to be there. But in the last 3-4 years, sending them to the ED for admission (since direct admits are essentially a thing of the past unless you book it 2-3w ahead of time) has become the only way to get things done. It's a drain on the patients, healthcare finances and all the unnecessary touches needed to get things done.

We're at the point where I'm struggling to find a place for consultants to see patients after I've assessed them in a triage chair and they need admission and the response I'm getting is "don't find a place, let the money making specialties see how bad it is and maybe something will change."

Our inpatient units are now camp grounds for patients that need long term care. Where are the death panels I was promised?

 

[gutonc]

We're at the point where I'm struggling to find a place for consultants to see patients after I've assessed them in a triage chair and they need admission and the response I'm getting is "don't find a place, let the money making specialties see how bad it is and maybe something will change."

The thing I don't get is that all of our medicine sub specialists (GI and pulm in particular) at the regional referral center are part of a physician owned MSG with their own imaging and ASC. They should be knocking down my door to get people in ASAP so they can do the procedures where they get the full physician and facility fee...that place should be running 20 hours a day. They are lousy with docs (>20 each for GI and Pulm, 8 colorectal surgeons, 4 thoracic, 3 foregut) so I am really struggling to find the problem there.

But that's a whole other issue.

 

[pkwraith]

honestly LOTS of lidocaine patches (weirdly I only write for 4%, so its OTC anyway), fioricet (local community freaking loves it but its generic anyway), Eliquis/other NOACs (what else am I going to do? Admit that DVT? never), and muscle relaxers of every single variety.

Its not even like this stuff should raise red flags, yet they do. I'm still ignoring them, but was creeped out by the number of indoctrinated people in the group who thought this was just a part of being an attending in EM.

You guys don't have elliquis and xarelto 30 day coupons stacked in every other drawers? You can also just print your coupons from their websites. Coupon, prescription, have send schedule PCP visit to preautho the rest.

 

[JacobMcCandles]

You guys don't have elliquis and xarelto 30 day coupons stacked in every other drawers? You can also just print your coupons from their websites. Coupon, prescription, have send schedule PCP visit to preautho the rest.

Those are good about half the time since they’re only available for people who haven’t had a previous script for those meds (at least I believe Eliquis is like that for sure).

 

[KGflyboy]

You guys don't have elliquis and xarelto 30 day coupons stacked in every other drawers? You can also just print your coupons from their websites. Coupon, prescription, have send schedule PCP visit to preautho the rest.

Actually I don't think you can anymore. I've tried. Do you have a link?

 

[pkwraith]

Actually I don't think you can anymore. I've tried. Do you have a link?

The public available one is for patients to use to request the card by email or text.
The one I have to directly print out the two eliquis cards is from our Bristol-Myer Squibb rep and it looks like it still works. I don't know if I can share it publicly because it has my institution in the url, but if you really want it, I can pm you it.