Psychiatrist Bills Pharmacy Manager for Time

At least one psychiatrist has taken a creative approach to dealing with the amount of time he spends seeking authorizations for prescription drugs from pharmacy benefit managers (PBMs).

He's billing the companies for his time.

Edward Gordon, M.D., chair of APA's Medicare Advisory Corresponding Committee, told Psychiatric News that he and other clinicians are spending extraordinary amounts of time filling out forms, talking on the telephone, and engaging in other activities in an effort to get authorization for use of medications for patients in the Part D prescription drug program.

So he's presenting the PBMs with a bill for reimbursement. Gordon told Psychiatric News that he has presented Medco—the largest PBM in New York state—a bill for more than six months' worth of uncompensated time spent by him or his staff seeking authorization.

“Pharmacy benefit companies have been occupying a great deal of physician time to solve their problem, in an effort to reduce usage of certain medications,” he said. “In doing so, they are asking doctors for services that are not part of the treatment. This is a service to Medco, not to the patient. So I'm sending Medco a bill for my time.”

Gordon added that not only is it a service to the company, it is one that frequently must be done on an emergency basis. “Otherwise the patient doesn't get the medication,” he said. “So not only are the PBMs requesting a service, but they are expecting me to drop everything to do it.”

Irvin (Sam) Muszynski, J.D., director of APA's Office of Healthcare Systems and Financing, has asked the federal Centers for Medicare and Medicaid Services to look into the matter of compensating physicians for the considerable time that many clinicians report having to spend seeking authorization.

But Gordon believes it is not the government that should have to pay for this time. “I think it's an expense that ought to be born by the pharmacy benefit manager that is asking for the service,” he said.“ The pharmacy benefit manager wants documentation that the use of the medication is professional, but it's been done dozens of times by other clinicians. So it's just harassment.”

Gordon said he recommends that other clinicians bill for their uncompensated time spent seeking authorizations. “I don't know what the outcome will be, but these companies are using up clinician time without paying for it,” he said.