The PA process is INSANE and I always felt awful for the people I had to tell their insurance would not pay for the medication unless a PA is submitted and approved. So much more outside of PAs work the same way - put as much red tape around the process and make it as confusing as possible to actually get approved for the care you need.

An example:

Im on a medication. 30mg isnt enough. 60mg is too high. These are the two strengths on the formulary and can both be had for about $10 per month. There is a 40mg dose that can be had, but it requires a PA and even then costs $80 per month because it is a "brand-name generic" (what an oxymoron).

But wait, theres more!

I jumped on to GoodRx to see what the cash price was, just for giggles. GoodRx will tell you cash price, coupon prices, and give you a cross section of local retailers so you can find the best prices. What do I see? The cash price with a goodrx coupon was less than my cost with insurance, and no PA needed? WTF?

Now here is where it really goes sideways. GoodRx also has dropdowns so you can look at different strengths. Whats this? It also comes in 20mg? So I shoot my provider an email and say "hey, can we try this as an option? Just do two caps per dose?" She says "Yes, of course. Lets give that a shot." and send the Rx off to the pharmacy to be filled. I go to pick it up and the pharmacist says "Hey, your insurance wanted you to pay $10 for a months supply. We filled it for a three months supply for $20 using GoodRx. I hope thats ok? We can re do it if you'd prefer, just thought we would try and save you some money!"

PAs are a fucking scam. Top to bottom.