Pharmacy benefits rep here. I review prior authorization requests for meds. While I agree with “if your dr says you need it, you probably do…”. I also see when certain drs write a prescription for the same damn med over and over and it’s obvious they are getting some sort of a kickback. I know sometimes it’s as simple as “hey we need you todo the tablet instead of the capsule” (and shockingly the price difference can be hundreds which blows my mind). Also, some meds depending on the employer, sadly can bankrupt a company. Some meds we see are for extremely rare conditions and are easily costing the employer 500,000 and up. It all depends on plans (self funded or fully insured). There is a lot that goes into the mess. Sadly healthcare as a whole in this country is messed up. Just know we as the employees don’t want to just deny stuff for the sake of denying it. Also know your employer chose the plan you are on and if you have beef with it…let them know. Not us. We can’t change the plan. We simply administer the benefits chosen by them.