The prescription comes from the doctor. We try to process it. It says, “special authorization required”. We call ESI, Express Scripts, Inc., which adjudicates on behalf of NIHB. We apply for the prior approval. NIHB sends the approval to the doctor. The doctor has to fill it out properly and send it back to NIHB. Then NIHB sends it back as either approved or denied.
There are multiple people involved. Faxes get lost. Sometimes the doctors are not available anymore, or the doctor has written a prescription and left already.
I had an incident yesterday where the patient came in and, after one month, the process is not complete. It went to the doctor's office. The paperwork got lost or they didn't know what to do with it, or the doctor wasn't available. The patient has not started their diabetes medication for over one month because of that.