Dar Haan spends a big portion of her day talking on the telephone to insurance company representatives, trying to get coverage for patient medications.

It's become a cumbersome and frustrating routine for the nurse, who works at the clinic Health Concepts in Rapid City.

"You almost need an extra staff person to do prior authorizations," she said. "A huge portion of our day is trying to get prior authorization on medication, and we just don't have the time to do that."

Although the economy hasn't pushed people to stop filling their prescriptions, it has changed the way insurance companies deal with those prescriptions. Local doctors and pharmacists report a huge jump in prior authorization requirements from insurance companies.

Prior authorization protocol requires a physician or nurse to contact the insurance provider to prove that a prescribed medication is needed and that other, less expensive, options have already been tried.

In the meantime, patients are left waiting for coverage, some going days without medication or struggling to pay out of pocket for medicines.

Ethel Freeman of Kadoka is one of those people.

Freeman, 76, began taking a brand-name medication for blood pressure in 2006. A month ago, when she called her pharmacy to refill the prescription, she was told that her insurance provider wouldn't pay for the drug any longer. That would mean paying $80 out of her own pocket.

After making countless phone calls and talking to her insurance carrier, Freeman was told that she needed to try a less expensive generic drug in order to be covered.

At the moment, Freeman's physician is trying to sort out the situation. Luckily, Freeman has enough medication to get by for a short time. "A lot of people are having this problem," she said. "I don't know what's happening."

Freeman is not alone in her confusion.

Farzaneh Fortier, a pharmacist at Boyds Drug Mart Express on Mount Rushmore Road, said a lot of patients struggle to understand why they suddenly have to wait to fill medications they've taken for years. Sometimes, the delays are caused by doctors who don't have time to give prior authorization in a timely manner. Sometimes, it's because an insurance company doesn't respond in a timely manner. "The patient is waiting, and I have to call and persist," Fortier said.

Fortier said the increase in pre-authorizations has been a growing frustration. "It's more work for us," she said. "You're already busy, … and then you're dealing with that issue."

Fortier said prior authorizations are being required even for patients who have previously taken a specific medication or have tried other alternatives. Even if they tried other medications, she said, "it has to be explained to the insurance company."

In the past, a doctor would write a prescription for a patient, and the patient would simply take the prescription to his pharmacist, who would fill it. An insured patient would most likely pay a co-pay, which is the portion not covered by an insurance comopany.

Today, the struggling economy has prompted more insurance companies to encourage the use of cheaper medications, often generics, instead of the more expensive brand names. In order to do that, they require patients to get a doctor's prior authorization before a prescription will be filled.

Kevin Teale, a representative for Wellmark Blue Cross Blue Shield, said the prior-authorization procedure is designed to encourage physicians to try less expensive yet often as effective medications first. A particular focus has been placed on generics.

"We've had a couple of initiatives to encourage the use of generics," Teale said. "It's going to take education to the general public that generics work."

In most cases, a generic medication is a pharmaceutical equivalent to a brand-name medication.

Dr. Paul Amundson, medical director of Dakota Care, said the main reason for the change in the prior-authorization procedure is the increasing expense of brand-name medications, which places a financial burden on health care providers.

"There are a lot more new medications available in the last year, and some are highly expensive," he said.

Teale said one example is a new heart medication used to treat a rare condition. The Food and Drug Administration recently approved the new treatment. It costs $500,000 a year per patient, Teale said.

"That's just an idea of the costs that are out there," Teale said. "As much as we can do to encourage the generics, … it will keep our costs down and lower our premiums."

But the change is costing pharmacists and patients their time.

Jo Prang at Medicap Pharmacy said, "It's supposed to take 72 hours to get your prior approval, but sometimes, it can take two or three weeks."

It's gotten so bad that at least one local doctor refuses to give prior authorizations any longer, she said. In addition to the time factor, health care providers are also concerned that insurance companies are affecting the way doctors treat patients. Haan said insurance providers are essentially second-guessing the treatment decisions made by a doctor.

"It's pretty bad when the insurance companies control what they can and can't have," Haan said of patients. "They're playing doctor is what they're doing. It's frustrating for us, and it's frustrating for physicians. It's like, 'Who's the doctor here?'"

For the time being, the prior-authorization trend seems to be here to stay, especially in light of current economic woes. Haan expects to continue spending her days on the phone, struggling to get patients the medication prescribed by their doctors. It's a future that makes her and other in health care weary.

"It's getting worse, and who knows where this economy is going," she said.

Contact Lynn Taylor Rick at 394-8414 or lynn.taylorrick@rapidcityjournal.com.