Difficulty navigating health insurance

Kaiser Health News published a reporter's personal account of difficulty in acquiring insulin, a common hormone used to treat diabetes. The main difficulty appears to be that the reporter's employer recently changed insurance providers, and the new insurance company required "prior authorization" (approval from the insurance company, usually requiring justification from the doctor). Compounding this issue was that the reporter also changed doctors around this time period, having to wait months for the first appointment with the new doctor. Additionally, the new insurance company did not cover the previously used brand of insulin, but rather a different one. While the reporter does eventually acquire insulin, the account ends on a funny (and sad note) about getting a call informing him that his new insurer was again waiting on a prior authorization (presumably for the next month's refill).

The reporter commented on how doctors oppose the practice of prior authorization, while insurers say they believe that the practice is useful for patient safety and for saving money. While prior authorization probably makes sense for some procedures, insulin does not seem like a great candidate for prior authorization. First, it seems unlikely that people would abuse insulin. Second, insulin requires a doctor's prescription (that is presumably time-limited and needs periodic refreshing) and I suspect that once people start taking insulin on a regular basis, it is fairly rare that they would stop; even if this point is not generally true, there is still the first point about why people would still buy insulin if they did not need it. Third, the price of insulin seems fairly small relative to a number of medical procedures, and perhaps even compared to the administrative cost of upholding the requirement for prior authorization. I suppose that an argument could be made for the opposite side that prior authorization might somehow reduce the possibility that someone who no longer needs insulin might be continuing to buy insulin in order to sell it for profit -- that seems unlikely to be happening too generally, but perhaps insurers have some data about this point. One point that is likely missing from the insurers' calculus is the administrative cost on providers' office staff to comply with prior authorization requirements.

There is also probably a smaller story about how electronic communication between providers' offices and insurance companies could reduce administrative costs on both sides (e.g. a provider's electronic medical record to send a request for prior authorization to the insurer). Another angle would be that ideally, a patient's medical record would be portable enough from one provider to another such that an insurer could accept it for prior authorization in cases like this one.