Enforcing strict utilization management during Sunday dinner, regional pharmacy benefit manager Greg Hutchins formally denied his own mother’s prior authorization for a GLP-1 this week, stamping NOT MEDICALLY NECESSARY across her cloth napkin.
“Rules are rules, Mom,” Hutchins said, passing the gravy. “Six months of a documented lifestyle program first.”
“I did Jazzercise in 1989,” his mother said. “Does that count?”
“Only if it was within the plan year.”
The denial stood for nineteen minutes. It ended when Mrs. Hutchins set down her fork, asked for the name and board specialty of the reviewer who had overruled her endocrinologist, and asked whether that reviewer would be putting the denial in writing with a signature.
Hutchins, who is the reviewer, reportedly looked at the napkin for a long moment, then approved the script before dessert.
At press time Mrs. Hutchins had asked whether the appeal could be expedited, and was told, quietly, that it already had been.
