I've never written a PA for any kind of insulin, but other meds? TNTC.
I get positive results with the following:
"The medications listed above [any other medications that my patient has used that are in the same general class of medications plus medications s/he has taken previously for the same/similar symptoms] have either been ineffective, only partially effective, or have caused intolerable side effects. A trial utilizing samples of _________________ has resulted in significant reduction in the frequency and intensity of this patient's symptoms."
PAs have a much better chance of getting approved if:
*No blanks are left unpopulated; use "N/A" when appropriate.
*Prior meds tried are listed by their generic names (even if a generic is not yet available for the medication) and the span of dates during which these meds were taken are listed alongside each med.
*Germaine chart notes, including but not limited to lab results, progress notes, medication flow sheets, and/or results of diagnostic and imaging studies are forwarded with the PA.
*No one lies.
Some health insurers play this little game. If a physician actually submits a PA in the manner in which I believe it is intended (the "P" stands for "Prior"), i.e. it is submitted before a patient takes their rx to the pharmacy and coverage is denied, the physician will receive a faxed reply stating that coverage for the medication was denied because it was sent in error due to the fact that the patient is not being prescribed this medication.
Other games health insurers play:
They deny coverage for a medication that is actually on their preferred formulary so the doctor spends a good chunk of "unbillable" time filling out the paperwork. Then a fax arrives that asks the doctor why a PA was submitted because medication X is a covered benefit.
A PA is approved, but the health insurer neglects to tell the physician or patient that it has been approved only at the highest tier possible and that the patient's copay will be some high percentage of the MSRP or the PBM's negotiated price du jour. The patient goes to pick up their rx and the pharm tech says "That'll be 27 bazillion dollars, please." The patient will not be able to afford it, and will become enraged at the doctor for prescribing something the doctor knew all along they could never afford. We actually don't know this. Everyone's plan is different, often for the same insurer. The same insurer will approve this particular med for say 10 patients in a row and then bam, this happens for your eleventh patient. Formularies and levels of coverage are "adjusted" without warning more often than I change my clothes. Websites are always down, navigation to the "special" formulary section for physicians requires a Ph.D. in computer science and a minimum of one hour, and/or the online formulary is not up to date.
A medication that requires a PA is approved. A dosage change is made and coverage for the same medication is denied. Another PA must be submitted before the insurer will cover the cost.
When I have more time I will list the other large handful of games they play.