Having good relationships with pharmacists

[PikminOC]

I try to answer phone calls ASAP from pharmacists and they appreciate it. I know you guys are under a lot of increasing pressure, metrics etc.
I try to be nice and reasonable.

Why do the insurance companies prescription plans try to put the patient on 3 month supplies within the first or second prescription? I am trying to adjust medications and cannot start people on 3 months of meds at that time.

I found some prior auths are ridiculous. One sends me a full page with nothing filled out on it. Then after that, they send me a second one for the specific medication. It's ridiculous. How do you think is the best way to handle these as I know this slows down the works for you guys too.

These pharmacy discount cards "Free USA " cards and the such. Cards with the American flag, etc are helpful for patients, but I looked over some threads here and I'm still not sure about the marketing, data mining, etc and if this is good for patient privacy. The cheaper lists at Walmart too have a notation that their information is utilized...

I hope other people put more questions on here too.
Thank you for your consideration.

---

Members don't see this ad.

 

[BeLikeBueller]

Why do the insurance companies prescription plans try to put the patient on 3 month supplies within the first or second prescription? I am trying to adjust medications and cannot start people on 3 months of meds at that time.

I've never seen an insurance plan force a patient to get 3 months of a med at a time. I've seen plenty that will force patients to get 30/31 days at a time, even though the script is written for 90 days. The only case that I could think of this occurring would be for patients who are receiving their prescriptions through their PBM's in-house mail-order pharmacy. In this case, it is probably in the best interest of the mail-order pharmacy/plan to get patients on 90 day supplies. But for those of us in big-box stores, I can't say that I've ever encountered this.

Do you have a specific situation that you could describe where insurance companies are trying to put patients on 3 month supplies?

Also, most of us never see the prior authorization forms that you have to fill out. At the end of the day, it all comes down to money though. The insurer doesn't want to pay for expensive medications (or even cheap ones, sometimes) if they don't have to. Hence all the step therapy, paperwork, and other hoops that you have to jump through. You're in a unique situation, if you're in psych though, since there is a lot of trial and error in your pharmacotherapy. I don't really know that there's a way around it...

 

[zelman]

I've never seen an insurance plan force a patient to get 3 months of a med at a time. I've seen plenty that will force patients to get 30/31 days at a time, even though the script is written for 90 days. The only case that I could think of this occurring would be for patients who are receiving their prescriptions through their PBM's in-house mail-order pharmacy. In this case, it is probably in the best interest of the mail-order pharmacy/plan to get patients on 90 day supplies. But for those of us in big-box stores, I can't say that I've ever encountered this.

Do you have a specific situation that you could describe where insurance companies are trying to put patients on 3 month supplies?

Also, most of us never see the prior authorization forms that you have to fill out. At the end of the day, it all comes down to money though. The insurer doesn't want to pay for expensive medications (or even cheap ones, sometimes) if they don't have to. Hence all the step therapy, paperwork, and other hoops that you have to jump through. You're in a unique situation, if you're in psych though, since there is a lot of trial and error in your pharmacotherapy. I don't really know that there's a way around it...

Forced 3 month Rx's happen at CVS when their Caremark policy treats it as mail order. Also, one of the MCO's in Massachusetts does the same thing. But neither do it on the first fill. Usually it's the third fill with no apparent dosage change that they want to cut down on dispensing fees.

 

[PikminOC]

Thank you both for your replies. I have seen this CVS thing on the second fill. When I increased lamotrigine!

 

[PikminOC]

I've never seen an insurance plan force a patient to get 3 months of a med at a time. I've seen plenty that will force patients to get 30/31 days at a time, even though the script is written for 90 days. The only case that I could think of this occurring would be for patients who are receiving their prescriptions through their PBM's in-house mail-order pharmacy. In this case, it is probably in the best interest of the mail-order pharmacy/plan to get patients on 90 day supplies. But for those of us in big-box stores, I can't say that I've ever encountered this.

Do you have a specific situation that you could describe where insurance companies are trying to put patients on 3 month supplies?

Also, most of us never see the prior authorization forms that you have to fill out. At the end of the day, it all comes down to money though. The insurer doesn't want to pay for expensive medications (or even cheap ones, sometimes) if they don't have to. Hence all the step therapy, paperwork, and other hoops that you have to jump through. You're in a unique situation, if you're in psych though, since there is a lot of trial and error in your pharmacotherapy. I don't really know that there's a way around it...

The prior authorizations take a great deal of time. Time that could be spent on more face to face patient care. This is why you may get resistance from doctors on it. First, the phone call that takes you through many hoops. Then the faxed in paperwork...

 

[owlegrad]

I have seen the forced 90 days thing many, many times. I have also seen forced 30 days as well. Funny that it goes both ways.

As for prior auths, I think it is safe to say that pharmacies hate those about as much as the prescriber does.

 

[WVUPharm2007]

I have seen the forced 90 days thing many, many times. I have also seen forced 30 days as well. Funny that it goes both ways.

As for prior auths, I think it is safe to say that pharmacies hate those about as much as the prescriber does.

I doubt it. We just hit he send button. They actually have to fill the damn thing out and fight with the PBM.

 

[owlegrad]

I doubt it. We just hit he send button. They actually have to fill the damn thing out and fight with the PBM.

Sure we just hit send...and then try to explain to the patient why we are refusing to give them their medication.

 

[npage148]

We have an insurance that requires 90d supply on all maintiance meds after the first fill. It drives doctors crazy because their definition of subsequent fills makes no sense so it's seemingly random

 

[ACE Rx]

I doubt it. We just hit he send button. They actually have to fill the damn thing out and fight with the PBM.

Nope. Pharmacists hate prior authorizations as much as physicians do. While physicians are fighting with the PBMs on why a patient should be on a certain medication, pharmacists are dealing with confused and often frustrated patients after having learned their diagnosis but insurance does not want to pay for their medication.

 

[SClENCE]

Caremark requires 90 day supply on refills all the time. It's annoying. You either send a fax and wait 1-3 days or have to call (which is the majority of the time as the patient is standing in front of you and mad). And then there's the time that they don't call in the refill until after the office is closed, the Dr. cannot be contacted, and the patient flips out because they got a 30 day supply last time and fails to understand.

As far as prior auths, it's as simple as clicking a button, but once the PA is approved we have no way of knowing, and if it's not we have no idea where the doctor/insurance are at in the process.

Not the doctor's fault but issues like these always consume the most time while at the same time pissing the patient off the most.

 

[PikminOC]

Nope. Pharmacists hate prior authorizations as much as physicians do. While physicians are fighting with the PBMs on why a patient should be on a certain medication, pharmacists are dealing with confused and often frustrated patients after having learned their diagnosis but insurance does not want to pay for their medication.

They get angry with us too.
Why isn't it done yet? etc.
It's a huge PITA.

 

[PikminOC]

Caremark requires 90 day supply on refills all the time. It's annoying. You either send a fax and wait 1-3 days or have to call (which is the majority of the time as the patient is standing in front of you and mad). And then there's the time that they don't call in the refill until after the office is closed, the Dr. cannot be contacted, and the patient flips out because they got a 30 day supply last time and fails to understand.

As far as prior auths, it's as simple as clicking a button, but once the PA is approved we have no way of knowing, and if it's not we have no idea where the doctor/insurance are at in the process.

Not the doctor's fault but issues like these always consume the most time while at the same time pissing the patient off the most.

They now require us to complete the PA and then call the pharmacy to let them know. The people who complete the PA don't do it. "We can't do outgoing calls".

 

[PikminOC]

Caremark requires 90 day supply on refills all the time. It's annoying. You either send a fax and wait 1-3 days or have to call (which is the majority of the time as the patient is standing in front of you and mad). And then there's the time that they don't call in the refill until after the office is closed, the Dr. cannot be contacted, and the patient flips out because they got a 30 day supply last time and fails to understand.

As far as prior auths, it's as simple as clicking a button, but once the PA is approved we have no way of knowing, and if it's not we have no idea where the doctor/insurance are at in the process.

Not the doctor's fault but issues like these always consume the most time while at the same time pissing the patient off the most.

I have patients who make the first apt and want ninety days.
Nooooooooo

 

[WVUPharm2007]

Nope. Pharmacists hate prior authorizations as much as physicians do. While physicians are fighting with the PBMs on why a patient should be on a certain medication, pharmacists are dealing with confused and often frustrated patients after having learned their diagnosis but insurance does not want to pay for their medication.

You guys must be terrible at explaining things. It takes me all of about 40 seconds to explain it. They might be perturbed at the PBM, but they generally accept it and I move on.

 

[owlegrad]

You guys must be terrible at explaining things. It takes me all of about 40 seconds to explain it. They might be perturbed at the PBM, but they generally accept it and I move on.

Or perhaps we deal with hundreds more patients than you and 40 seconds is a long time to spend with one person for us?

 

[WVUPharm2007]

Or perhaps we deal with hundreds more patients than you and 40 seconds is a long time to spend with one person for us?

No it isn't. Stop exaggerating. That's less time than actually filling the hing by far.

 

[owlegrad]

No it isn't. Stop exaggerating. That's less time than actually filling the hing by far.

But just standing around talking to someone for 40 seconds? Huge time waste. And there are many people who won't let it go in 40 seconds, your incredible communication skills notwithstanding.

 

[PikminOC]

Correct. Time adds up.

 

[zelman]

You guys must be terrible at explaining things. It takes me all of about 40 seconds to explain it. They might be perturbed at the PBM, but they generally accept it and I move on.

You: 40 second explanation
Them: "But they paid for it last time"
You: explain that they have a new insurance plan.
Them: "This new one paid last month"
You: explain transition fills
Them: "But my doctor ordered this because I need it"
You: That first 40 second explanation they've forgotten because they have the short term memory of a goldfish

..and so on and so forth. There are times when 40 seconds will do, but it's not always that simple...and when it is, I don't have 40 seconds to waste.

 

[trailerpark]

I don't answer phones or do drop off or register, that's what techs are for. I rarely fill, and I still barely get everything done before close and now Walmart is pushing immunizations...

 

[farmadiazepine]

I think we can all agree PBMs suck. For some reason here in America we have a really bad health care system in terms of payers. Why do we have middle men deciding what a health care provider can and cannot do, especially when they make their decision on back room deals with drug manufacturers? The payer/payment model needs to change. Canada is a great model of what our country should do in terms of health care.

 

[PikminOC]

Any differences between Canada and America that would make that unsustainable?

 

[Jibby321]

I don't answer phones or do drop off or register, that's what techs are for. I rarely fill, and I still barely get everything done before close and now Walmart is pushing immunizations...

How many scripts do you do a day? Are you utilizing central fill?

 

[PikminOC]

No it isn't. Stop exaggerating. That's less time than actually filling the hing by far.

Please define PBM.
And it takes a lot more than 40 seconds for me to deal with one of these.

 

[WVUPharm2007]

Please define PBM.
And it takes a lot more than 40 seconds for me to deal with one of these.

Pharmacy Benefit Manager. I.E. Caremark, Express Scripts, Aetna, etc.

 

[PikminOC]

Pharmacist called me today telling me ambien dose is too high on a patient. She had bariatric surgery so has weird absorption. I had told the pharmacist this last month. She let the meds go thru that time.
This time she asked me many more questions and said she was just off the phone with the manufacturer. She asked me what else we had tried, etc.
I told her to have the patient go to another pharmacy and I told the patient the same.
This was walgreens.
It wasn't an insurance issue.
It was the pharmacist.

 

[trailerpark]

How many scripts do you do a day? Are you utilizing central fill?

350-400

 

[Jibby321]

350-400

That's not terrible.

 

[Deja]

350-400

whaaa, I heard walmart give you tons of tech hours tho! I used to work at a store that does that much script and sometimes i had to go to the drop off while my tech counts and getting pick up... i also answered phones... maybe you need to change your workflow

as for 90 days fill, in cali, pharmacists can dispense 90 days if there is enough refills on the scripts

 

[Jibby321]

whaaa, I heard walmart give you tons of tech hours tho! I used to work at a store that does that much script and sometimes i had to go to the drop off while my tech counts and getting pick up... i also answered phones... maybe you need to change your workflow

as for 90 days fill, in cali, pharmacists can dispense 90 days if there is enough refills on the scripts

I agree with the workflow comment.

 

[zelman]

Any differences between Canada and America that would make that unsustainable?

It's fine model if you don't want any new drugs to ever be developed.

 

[usechopstix]

Pharmacist called me today telling me ambien dose is too high on a patient. She had bariatric surgery so has weird absorption. I had told the pharmacist this last month. She let the meds go thru that time.
This time she asked me many more questions and said she was just off the phone with the manufacturer. She asked me what else we had tried, etc.
I told her to have the patient go to another pharmacy and I told the patient the same.
This was walgreens.
It wasn't an insurance issue.
It was the pharmacist.

As a pharmacy intern I've seen this scenario all too often. This might be explained from the pharmacist education that puts a strong (sometimes restraining) emphasis on therapeutic dosing, adjusting for co-morbidities, and drug interaction. So much so that it sometimes really makes the pharmacist seem like the police rather than a healthcare professional. That said, if the conversation was already had last month, they really should have had a note in their system stating so. I'd be annoyed too if I had to have the same talk with every fill.

 

[PikminOC]

As a pharmacy intern I've seen this scenario all too often. This might be explained from the pharmacist education that puts a strong (sometimes restraining) emphasis on therapeutic dosing, adjusting for co-morbidities, and drug interaction. So much so that it sometimes really makes the pharmacist seem like the police rather than a healthcare professional. That said, if the conversation was already had last month, they really should have had a note in their system stating so. I'd be annoyed too if I had to have the same talk with every fill.

She didn't want the same talk. She wanted a lot more information.

 

[RxMonkey]

Not sure which state you practice in, but bills are in committee right now in various states that would require insurance companies to have PA or Step-therapy protocols approved by governmental review board. For instance, in FL SB 784 and HB 863 (http://floridapolitics.com/archives/8022) are trying to do just that. Write your representative and demand they support such legislation.

I'll get off my soapbox now.

 

[molyhelp]

I try to answer phone calls ASAP from pharmacists and they appreciate it. I know you guys are under a lot of increasing pressure, metrics etc.
I try to be nice and reasonable.

Thank you, if you hear a pharmacist calling you and start with "Sorry to bother you...that's me. I try to be nice and reasonable, too.

I found some prior auths are ridiculous. One sends me a full page with nothing filled out on it. Then after that, they send me a second one for the specific medication. It's ridiculous. How do you think is the best way to handle these as I know this slows down the works for you guys too.

Why different faxes? Some faxes are sent by technicians, some faxes are sent by pharmacists. If you see specific medication, we are trying to help you by suggesting the COVERED medications that we think are in the same class or may do the same job. We are trying to save you hours from fighting with insurance. For example, Flonase generic was covered last year with California Medicaid, this year? Astelin generic. Omeprazole was covered last year, this year? Nexium brand! or Pantoprazole. We were trained to know some alternatives may work and may save you time. Before you waste time to insist with insurance on a certain Flonase, we welcome you calling pharmacy first and work with technician, live phone call, to try any med you like, perhaps Astelin will be acceptable with you which you will find out quickly by asking pharmacy members to try a few in the same class.

These pharmacy discount cards "Free USA " cards and the such. Cards with the American flag, etc are helpful for patients, but I looked over some threads here and I'm still not sure about the marketing, data mining, etc and if this is good for patient privacy. The cheaper lists at Walmart too have a notation that their information is utilized...

We all have the heart to help patients and we know most patients love to pay less to take antibiotic home that night. I have seen discount card that knocked down Levofloxacin from over 100 dollars to be under 20 dollars. I would want that for my mom too if I was on the other side of the counter. Depending on the District Mangers, I have seen pharmacies that accept those discount cards and help patients (as well as some branches of the same chain refusing. Why? the reason to accept depends on the pharmacy manager or District Manager). Some managers prefers to get the script done and over with, we have typed the script, counted the pills and printed label, might as well take the discount card and finish the script. Some managers are afraid of hidden issues (privacy as you mentioned, hidden fees...). Some managers don't know and just take the card to finish the script and have script count goes up (for job security.) So, if the patient is lucky, the discount card will most likely be accepted and will help patient. If certain pharmacy refuses, tell patient to try another pharmacy, not all pharmacy managers are educated the same way, some pharmacy managers are brand new graduate from school.

Thanks for looking for the poor and sick. We will do the same.

 

[molyhelp]

You: 40 second explanation
Them: "But they paid for it last time"
You: explain that they have a new insurance plan.
Them: "This new one paid last month"
You: explain transition fills
Them: "But my doctor ordered this because I need it"
You: That first 40 second explanation they've forgotten because they have the short term memory of a goldfish

..and so on and so forth. There are times when 40 seconds will do, but it's not always that simple...and when it is, I don't have 40 seconds to waste.

Here is my 40 seconds...

Them: "But they paid for it last time".
Sorry, this month, insurance is being cheap. Your doctor must insist with insurance for you.

Them: "This new one paid last month"
Sorry, this month, insurance is being cheap. Your doctor must insist with insurance for you.

Them: "But my doctor ordered this because I need it"
Sorry, this month, insurance is being cheap. Your doctor must insist with insurance for you.

I am your friend. I want to give this to you. Your insurance is being cheap. Your doctor must insist with insurance for you.

My patients love me...because I clearly present that I am a friend.

 

[zelman]

Here is my 40 seconds...

Them: "But they paid for it last time".
Sorry, this month, insurance is being cheap. Your doctor must insist with insurance for you.

Them: "This new one paid last month"
Sorry, this month, insurance is being cheap. Your doctor must insist with insurance for you.

Them: "But my doctor ordered this because I need it"
Sorry, this month, insurance is being cheap. Your doctor must insist with insurance for you.

I am your friend. I want to give this to you. Your insurance is being cheap. Your doctor must insist with insurance for you.

My patients love me...because I clearly present that I am a friend.

Oooooooh. I see. You're just a douchebag to people in desperate situations. Yes. I can see how that would be faster.

 

[PikminOC]

Why different faxes? Some faxes are sent by technicians, some faxes are sent by pharmacists. If you see specific medication, we are trying to help you by suggesting the COVERED medications that we think are in the same class or may do the same job. We are trying to save you hours from fighting with insurance. For example, Flonase generic was covered last year with California Medicaid, this year? Astelin generic. Omeprazole was covered last year, this year? Nexium brand! or Pantoprazole. We were trained to know some alternatives may work and may save you time. Before you waste time to insist with insurance on a certain Flonase, we welcome you calling pharmacy first and work with technician, live phone call, to try any med you like, perhaps Astelin will be acceptable with you which you will find out quickly by asking pharmacy members to try a few in the same class.
--
I have seen Prior auths even with generics nowadays.
You guys send me the fax with member ID and phone number.
I call the number and am transferred to a different phone number.
In the case of blue cross, they will not do the prior auth over the phone.
They send me a blank sheet with no patient info filled out and have me fill out everything.
Then they review it and send me a more specific sheet such as "controlled substance prior auth".
So then I fill that out and fax back.
Patient can wait up to 14 days for the prior auth.
This is what us physicians are dealing with.
There is a reason we prescribe what we prescribe. I cannot change a medicine at the whim of the insurance company.

 

[PikminOC]

We all have the heart to help patients and we know most patients love to pay less to take antibiotic home that night. I have seen discount card that knocked down Levofloxacin from over 100 dollars to be under 20 dollars. I would want that for my mom too if I was on the other side of the counter. Depending on the District Mangers, I have seen pharmacies that accept those discount cards and help patients (as well as some branches of the same chain refusing. Why? the reason to accept depends on the pharmacy manager or District Manager). Some managers prefers to get the script done and over with, we have typed the script, counted the pills and printed label, might as well take the discount card and finish the script. Some managers are afraid of hidden issues (privacy as you mentioned, hidden fees...). Some managers don't know and just take the card to finish the script and have script count goes up (for job security.) So, if the patient is lucky, the discount card will most likely be accepted and will help patient. If certain pharmacy refuses, tell patient to try another pharmacy, not all pharmacy managers are educated the same way, some pharmacy managers are brand new graduate from school.
--
My question was to make sure their information was protected and wondering what the catch was.

 

[PikminOC]

Thank you, if you hear a pharmacist calling you and start with "Sorry to bother you...that's me. I try to be nice and reasonable, too.
--
I don't need a pharmacist to say that to me.
I can be nice without that.

 

[SClENCE]

If an insurance covers free style test strips and the doctor writes it for one touch, is the best route to just fax the MD the rejection and write on it what they do cover? Same goes for 90 day supply requirements... is this what you prefer... just faxing the rejection and writing on it that it requires 90 day supply to clarify? Then you can just send over a new prescription.

Seems to be the least time consuming way to do it... though I'm half tempted to just change it without asking when it's something like test strips.

 

[zelman]

There is a reason we prescribe what we prescribe...

For psyche, probably. For most docs, there often isn't. Why prescribe one inhaled steroid vs another? One PPI vs another? Tablets vs capsules? There can be a reason for all of these, but typically it's an arbitrary choice.

 

[PikminOC]

For psyche, probably. For most docs, there often isn't. Why prescribe one inhaled steroid vs another? One PPI vs another? Tablets vs capsules? There can be a reason for all of these, but typically it's an arbitrary choice.

I don't know other fields as well.
But I do know mine!

 

[npage148]

We were trained to know some alternatives may work and may save you time. Before you waste time to insist with insurance on a certain Flonase, we welcome you calling pharmacy first and work with technician, live phone call, to try any med you like, perhaps Astelin will be acceptable with you which you will find out quickly by asking pharmacy members to try a few in the same class.

NO, please do not do this. It is a waste of the pharmacy's time. We are not forumlary handbooks and I have little patients for nurses/doctors that are looking to use me so they don't have to be bothered figuring out a formulary because they are oh so busy. If you try this with me on a good day I may be helpful to a point but on an average to bad day and I'll just suggest you call the 1800 number on the patient's card in hasty terms

 

[Carboxide]

Why different faxes? Some faxes are sent by technicians, some faxes are sent by pharmacists. If you see specific medication, we are trying to help you by suggesting the COVERED medications that we think are in the same class or may do the same job. We are trying to save you hours from fighting with insurance. For example, Flonase generic was covered last year with California Medicaid, this year? Astelin generic. Omeprazole was covered last year, this year? Nexium brand! or Pantoprazole. We were trained to know some alternatives may work and may save you time. Before you waste time to insist with insurance on a certain Flonase, we welcome you calling pharmacy first and work with technician, live phone call, to try any med you like, perhaps Astelin will be acceptable with you which you will find out quickly by asking pharmacy members to try a few in the same class.
--
I have seen Prior auths even with generics nowadays.
You guys send me the fax with member ID and phone number.
I call the number and am transferred to a different phone number.
In the case of blue cross, they will not do the prior auth over the phone.
They send me a blank sheet with no patient info filled out and have me fill out everything.
Then they review it and send me a more specific sheet such as "controlled substance prior auth".
So then I fill that out and fax back.
Patient can wait up to 14 days for the prior auth.
This is what us physicians are dealing with.
There is a reason we prescribe what we prescribe. I cannot change a medicine at the whim of the insurance company.

We deal with the exact same crap, trust me. Patient needs a copay override called for every month? Okay. Three hours later...ugh.

And I agree with whoever said that the vast majority of physicians don't have a good reason for writing for a specific drug over another one. Most have one drug name they immediately think of and write for despite there being alternatives. Nobody really needs candesartan instead of losartan.

 

[owlegrad]

NO, please do not do this. It is a waste of the pharmacy's time. We are not forumlary handbooks and I have little patients for nurses/doctors that are looking to use me so they don't have to be bothered figuring out a formulary because they are oh so busy. If you try this with me on a good day I may be helpful to a point but on an average to bad day and I'll just suggest you call the 1800 number on the patient's card in hasty terms

I was thinking the same thing. If you called and asked me what would be cheaper for the patient I would tell you I don't know, unless it was one of the very rare times the rejection message actually told us the preferred agents.

 

[npage148]

In which case the preferred substitute would be listed on the fax I sent you

 

[SClENCE]

If you need to know what is covered/cheaper, why in the world would you call the pharmacy and not the insurance company? This is something that truly get old. Patients asking what is cheaper/covered/how much will this be etc... then they say "I have Anthem". OKAY... which one of their 500 plans do you have? You know the drug name but cannot tell me the strength or quantity? You want to know how much your deductible is? You want to know why your co-pay went from $1.20 to $2? You want to know much much the pharmacy across the street charges for it? These are all great questions for your insurance company... but I'm sure you'll pay the cash price for your dilaudid anyways as I return your child's eye drops that are "a rip off".

Then there are the people that wait to hand me the insurance card as I ring them up... because I can submit claims to medicaid from my cash register. Sorry lady, Allegra D is not covered... "Here's 20 discount cards, use whichever is cheapest"... okay it will be 15 minutes... "15 minutes? It was supposed to be ready!"

No we do not have this medication in stock. "Does rite-aid have it?" Do they really think that I can pull up the balance-on-hand of my competitors? Or are they just lazy and want me too call for them and ask?

Ok done ranting (for now)

 

[PikminOC]

Today I called the pharmacy and patient and told them I'm not going to do the prior auth.
Done and done.