A few weeks ago, I saw a young patient who was suffering from an ear infection. It was his fourth visit in eight weeks, as the infection had proven resistant to an escalating series of antibiotics prescribed so far. It was time to bring out a heavier hitter. I prescribed ciprofloxacin, an antibiotic rarely used in pediatrics, yet effective for some drug-resistant pediatric infections.
The patient was on the state Medicaid insurance and required a so-called prior authorization, or PA, for ciprofloxacin. Consisting of additional paperwork that physicians are required to fill out before pharmacists can fill prescriptions for certain drugs, PAs boil down to yet another cost-cutting measure implemented by insurers to stand between patients and certain costly drugs.
The PA process usually takes from 48 to 72 hours, and it’s not infrequent for requests to be denied, even when the physician has demonstrated an undeniable medical need for the drug in question.
I saw my patient with the persistent ear infection on a Thursday afternoon. It would be Monday, at the very earliest, that his ciprofloxacin prescription could be filled — provided the insurance company granted my PA request. Because he needed the drug as soon as possible, the patient’s mother and I called the pharmacy to see how much a 100 mL bottle of ciprofloxacin would cost if she were to pay out of pocket. The answer was $135 — an almost unthinkable sum for a single mother of three who was working two jobs to make ends meet.
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