Sheets of Ice: Prior Authorizations

In good weather we don’t think about sidewalks. We run, ramble, push strollers and walk our dogs, taking no more notice of the sidewalk’s surface than the air we breathe. When a wicked winter storm encases the concrete in ice, we notice. Have you ever stood on ice so thick it was beyond salt and your best shovel? Ice that made your familiar front steps inaccessible? That’s what it’s like for some patients and their treating physicians caught in the prior authorization process with insurers. 

In a January 30, 2023 piece in The Washington Post, Carolyn Y. Johnson describes her experience trying to get approval for anakinra, a drug to treat her son’s rare type of childhood arthritis called systemic onset juvenile idiopathic arthritis, or sJIA. See “I Wrote About High-Priced Drugs for Years. Then my Toddler Needed One.” A few days later, on February 2, ProPublica published an article about Penn State University student Christopher McNaughton, who has severe ulcerative colitis. See “UnitedHealthcare Tried to Deny Coverage to a Chronically Ill Patient. He Fought Back, Exposing the Insurer’s Inner Workings” by David Armstrong, Patrick Rucker and Maya Miller.

The relief of finding an essential medication that works, only to have it become financially unavailable is exactly like this. We can do better. 

From a photo by Dylan Calluy on Unsplash