Stable genius

Most calls here are the callers being irrational. This isn’t one of them.

I work for a pharmacy benefits manager. We get calls from pharmacies when they are having trouble billing insurance for prescription drug claims.

Me: thank you for calling (company), how may I assist?

Pharmacist: I can’t get this claim for Z-pack (Azithromycin, a common antibiotic) to go through, why is it rejecting?

Me: there’s new quantity limits on this and hydroxycloroquine and the member has already had 1 fill in the last 60 days, so this will need a prior authorization (where the doctor has to petition the insurance why they should cover this med).

Pharmacist: But why? This is an antibiotic for the patient’s pneumonia (and it’s really cheap), why would that require a prior authorization?

Me: Because these medications have been suggested to be used in the treatment of Covid-19, the insurance companies have put quantity limits on them to prevent national shortages.

Pharmacist: But there is no treatment for Covid-19. Hydroxycloroquine and Z-pack together haven’t been proven to actually work. So you’re saying because (you know who) /suggested/ it could be used for Covid-19 without hardly any proof, this person is going to have to wait (potentially days) to get their antibiotic for their pneumonia while the doctor does a prior authorization?

Me: …yes, that’s correct….

Pharmacist: Okay, I just wanted to make sure I understood.

(I then cried a bit internally and had to talk myself out of quitting.)

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