I'm yet another CalPERS member with this problem. I've had an Anthem PPO plan for over ten years, and I've been taking medications requiring prior authorizations the entire time.
In the past ten years, not a single one of my PAs has been denied...until now. Sure, Medco and Caremark occasionally gave me problems ("lost" approvals, unnecessary extra requests, etc.); however these problems NEVER included denials. Since January 1st, several of my co-workers have reported long delays with their PA approvals. Well, it's amazing how quickly they respond when they decide to deny it!
I've requested two PAs in the past two weeks, and both denials were received within 48 hours of the request. Now my only option is to spend almost half of my paycheck on a one-month supply (because if I don't I'll end up in the hospital). Oh, and as if that wasn't bad enough...Both times they denied me, I was notified by automated phone calls on weekend days (one Saturday, one Sunday) at 7AM on the dot. Thank you, OptumRX, for interrupting the only quiet time I have all week (and waking up everyone else in the house).
I ignored the 2nd 7AM call and turned off the ringer...at 10AM I checked the caller ID, and they'd literally been calling every fifteen minutes! Apparently messing with peoples' health just isn't enough fun for them.
If these issues aren't addressed soon, the state will have a helluva problem to deal with. Productivity will go down the toilet if half of the workforce can't get their meds.
Product or Service Mentioned: Optumrx Customer Care.
Reason of review: Denial of coverage.
Monetary Loss: $900.
Preferred solution: Medication coverage.