So, here is another great example of why I get so fired up about insurance plans and the prior authorization process. For privacy reasons in this case, I will not reveal the name of the health plan. Below (redacted to preserve identity) is what I sent explaining my choice of Rozerem, a non-addictive sleep drug. Despite what I wrote, I was told that temazepam or zolpidem had to be tried first.
Insomnia has been an issue with patient A. Patient A cannot take benzodiazepines (temazepam, estazolam) for sleep because of a history of addiction. If there is random drug screen at work that class of medications will produce a positive urine. Zolpidem (IR, CR), zaleplon and eszopiclone may also pose abuse risks. Also, zaleplon is NOT indicated for chronic, persistent insomnia and is only used for initial insomnia or middle insomnia anyway. Patient A tried trazodone but was far too sedated the next day, even on a very low dose. If his Patient A’s insomnia is not treated, Patient A cannot function the next day at work and also notes worsening depression. Rozerem is one of only two sleep drugs that are FDA appoved for long term management of insomnia (eszopiclone (Lunesta) being the other) and it has no dependency potential.
How much clearer could I have been? The medical director with whom I spoke assured me that “the forms get scanned into the computer and sometimes we don’t get all the information sent over.” It should be noted that there was only one form with one page of actual patient and clinical information. I was told that the medical director who reviewed, therefore, must not have “gotten that page,” but when I asked him to look at what they had received, he began reading from the same page that I had sent. When I directed him to the box for written explanations, he then saw the above paragraph. He had no explanation why it had either been ignored, perhaps not read at all, or deemed not important enough not to deny the Rozerem. Multiple times, he assured me that he will “have to look into this.” How empty that sounded. This was not the first time with this health plan that I had the same issue with the same. Of course, after speaking with me (which took three separate calls), the Rozerem was approved.
If you are a physician reading this, please know that though this is very time consuming and causes a lot of aggravation, our patients are not at fault nor responsible for their insurance plans. And we shouldn’t have to go through such as arduous process each time we want to prescribe a medication. If you are a patient or someone who has been on the other end of one of these decisions, know that with some diligence and persistence on the part of your doctor of the doctor’s staff, you can get the medication he or she prescribed originally. It should never be that the insurance company should be making decisions about your care.