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
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
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
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.