What is a prior authorization?

The below is from an insurance company that explains it.  For patients with diabetes, this happens all the time as most medications are new and require prior authorization.  This creates the need for pharmacists and physicians to work together.  At EPC, we are working to create this environment where pharmacists and physicians work side by side to avoid these prior authorizations.
To avoid delay in medication and to lower cost and save time, we recommend that you use Privia pharmacy as we can easily communicate with the pharmacist and avoid and manage these prior authorizations in a timely manner.
(below from a national insurance company). 

What is prior authorization?

This means we need to review some medications before your plan will cover them. We want to know if the medication is medically necessary and appropriate for your situation. 

If you don’t get prior authorization, a medication may cost you more, or we may not cover it.

If you file an urgent request, we will have a decision provided in 72 hours or less. For an urgent review of a non-covered drug, one not on your drug list, we will have a decision in 24 hours or less. A standard request may take up to 15 days for us to make a decision.

What kinds of drugs need prior authorization?

  • Drugs that have dangerous side effects
  • Drugs that are harmful when combined with other drugs
  • Drugs that you should use only for certain health conditions
  • Drugs that are often misused or abused
  • Drugs that a doctor prescribes when less expensive drugs might work better

How do I find out if my medication needs prior authorization?

We cover certain drugs under the pharmacy part of your insurance and others under the medical part of your insurance.

What should I do if my prescription needs prior authorization?

If your drug needs approval, either you or your pharmacist will need to let your doctor know. Your doctor might switch you to another drug that doesn’t need prior approval. 

Basics of Thyroid Cancer

The incidence of thyroid cancer is increasing as more screening is being done and more nodules in thyroid are being uncovered.  According to American Cancer Society there were 52,890 new cases of thyroid cancer in the US in 2020 (12,720 in men and 40,170 in women). Generally, a nodule is picked up either by feeling a lump in the neck, thyroid ultrasound or incidental imaging of the neck.  Thyroid gland is located at the base of the neck. So, if you notice any lumps or bumps in that area you should get them checked out. Women are at higher risk for developing thyroid cancer. Some of the other risk factors include family hx of thyroid cancer and radiation around the neck area. Thyroid cancer cannot be initially diagnosed through blood work. It is mostly diagnosed via biopsy where the doctor inserts a tiny needle in the nodule with help of ultrasound and obtains some specimen.  Sounds frightening, but most of the time you only feel a pressure like sensation and before you know it, it’s done! Our doctors have years of experience with this! Treatment generally involves removing thyroid tissue depending on the size and involvement. Most people end up needing long term thyroid hormone replacement after surgery. Some also require additional treatment with radioactive iodine to ablate any residual tissue. Normally the decision for iodine treatment is dependent on the size and spread of the cancer.  Thyroid cancer is one of the least aggressive types of cancer. While its prognosis is excellent, the rate of recurrence can still be from 20-30%. Therefore, it is always a good idea to follow up with your provider in a timely manner so that they can keep track of the tumor markers.   To learn more about thyroid cancer or if you have any questions please contact us.

Author: Physician Assistant Sanket Shah

Don’t Forget About Yourself Ladies!

Lets face it, you are busy!  Most of you have full time jobs.  Most of you come home and have to be a full time moms.  You don’t have time to take care of yourself.  You are too busy taking care of others that you neglect yourself.  Well, if you don’t take care of yourself, you will have a heart attack!  

We have this notion that only men die of heart attacks, and women live forever.

What is the #1 cause of death for women?

Heart disease.

Risk factors for heart disease include high blood pressure, diabetes, high cholesterol, being overweight, smoking, physical inactivity, and genetics.

There are multiple ways to avoid this for the long term.  Some are with medications and others from lifestyle changes.

The good news is that at EPC we know about a cheap and effective treatment that everyone can have access to!  It will not only decrease your risk of heart disease, but it will also improve diabetes, high blood pressure, and cholesterol.  Side effects include increased energy and a healthier you!

What is it?  Weight loss and increased physical activity!  Did you know that just a 5-10% weight loss can have a HUGE impact on your risk for diabetes?  Increasing your physical activity by walking for just 30 minutes per day can not only decrease your risk for heart disease, but it will also make you feel better both physically and mentally.  To help with weight loss, Americans need to eat MORE.  That is right, we need to eat MORE vegetables, fruits, whole grains, legumes, and lentils.  By eating more of these high fiber foods, we naturally eat less of the foods that lead to difficulty losing weight.  These foods also fuel our bodies and give us ENERGY!

Come see us to see how else we can help you live longer and be there for your family as well as yourself.

Author: Dr. Valerie Butler (Endocrinologist)