Humana ALWAYS screws up my regular, traditional, typical every 90-day insulin prescription renewals by putting the order on hold until my endo sends them a prior authorization. They always insist they need it when I call and complain for holding up the order. My endo always insists they do not, but thankfully she always does what Humana insists and I always eventually get the insulin
What d’ya all know about prior authorizations? Does Medicare require them? Do they need to be reissued by your Dr annually?
I am not sure exactly what happens behind the scenes with my Part B insulin. Technically they need chart notes from the endo to prove that I have been seen in the last 90 days and still fit the requirements for pump coverage under Medicare. Other months they ask me when my last endo visit was and I have no idea whether they contacted her. I do know that when I go to Arizona for the winter, the Walgreens there requires a new prescription saying that Medicare doesn’t allow transferred prescriptions. I rarely get my Part B insulin in one day like other prescriptions. It usually takes 3-5 days to get everything right and sometimes for the pharmacy to get enough Novolog in vials for my 90-day supply. I thInk that most of the insulin pharmacies supply is in pens since we pumpers are a distinct minority. I also think my pharmacies have many more Humalog users than Novolog.
Yeah this is screwy! Right as I was chatting with the 2nd or 3rd chatter at Humana, who INSISTED they need a new PA annually, I got a text msg from their pharmacy app saying my order is being filled and they’d notify me when they ship it! Clearly no one at my endo had had time by then to send them anything even though my endo still insists they do NOT need one since insulin IS in my formulary. It’s obvious to me Humana’s left hand has absolutely no clue at all what it’s right hand is up to!
@Tom_in_SC my employer sponsored health plan requires an new PA at the beginning of every calendar year, even if I have an existing PA that’s in force that extends from December to April. The rational to I have been given by more than one DME supplier is that I may possibly in an alternate reality have changed health plans between December and January, even though my plan changes every July. Go figure.
Yes, my employer sponsored health plan fired all the HR employees at headquarters and outsourced everything to India. The new outfit now has Prior Authorizations for all kinds of stuff.
To top that off, for any prescription coming up for renewal in January, there is a very real triple witching:
1: Health plans that actually did change at start of new year.
2: As you point out, prior authorizations that may have previously been good for a year, now magically go out of effect on Jan 1.
3: Doctor’s offices are out on holidays for first week of new year.
To make it even worse, there’s a quadruple witching the past two years:
4: Doctor’s offices laid off gobs of staff in early 2020 and now can’t hire any to do the ever-increasing amount of PA paperwork.
I myself have been caught in a Catch-22 where as a patient I call my pharmacy, insurance company, and doctor’s office EVERY SINGLE DAY for the whole month of January in an attempt to move along a “stuck” prior authorization (a document that I have never actually laid eyes on myself.).
My only advice, is try your best to slide your 3-month renewals early or late so that nothing requires a Prior Authorization anytime in the month of January. If you have to do monthly renewals, well I don’t know what to do there.
I try and game the system like I suspect many here do by “loading up” on refills in December to carry me through as far into the first quarter of the new year as possible.
I start new PAs early even if I’m not due for the refill yet by having the Dr write a new Rx which changes the Rx cycle and lets me game the system. New year, new cycle, new clock. This allows for the inevitable paperwork snafus and lets me capitalize on the end of year refills which hopefully will be free (if I manage to hit max oop)
Yeah, El-Ver, I agree loading is a practice I need to do better at! I tend to count my supplies and hold off longer than Humana’s reminders say, but it won’t hurt to load up, as you say. Esp if I do so for insulin right before year end!
@Tom_in_SC I hoard like the apocalypse is coming to build up my rainy day supply. When my supply gets to a comfortable max or becomes cumbersome/ I have rotation or date code issues, I share my hoard with diabetics that are less fortunate to get my supply to a more manageable level. Waste not want not and prepare for the unexpected. Nothing is ever disposed of, it is always utilized and PAs are merely an annoyance that need to be navigated at the beginning of the year.
