Meeting the Growing Prior Authorization Challenge for Physician Practices

PARx reduces PA barriers, providing effective access to the medications physicians deem best for their patients

PARx Solutions is spreading the word, and physician practices are listening: the company’s streamlined, user-friendly, full service approach to Prior Authorization (PA), the requirement by a patient’s health plan to approve a specific medication as a condition of providing coverage, is successfully helping healthcare providers meet this growing concern.

The PARx prior authorization service, provided at no cost to physician practices, has been proven effective with most therapeutic areas and across managed care plans. PARx has successfully processed PA requests for tens of thousands of prescribers across a spectrum of therapeutic areas including gastroenterology and diabetes, and represents a critical mass of medications in the ophthalmology and optometry areas. Said Dr. Harvey Richman, FAAO, FCOVD, Diplomate American Board of Optometry,Manasquan, NJ: “By using PARx Solutions’ services, my practice is doing far more PA’s more quickly, more efficiently, meaning that less doctor and staff time are wasted.”

The evolving PA landscape presents numerous challenges for physicians and their practice managers, including: an increase in the number of medications requiring PA; PA request forms that change over time and are different by plan; patients who change insurance plans due to a change in employment or due to the ACA (Affordable Care Act) may find they need PA for long-term medications; and PA requirements that have become overall more stringent and complex. Furthermore, pharmacy data shows that when a prescription is rejected, requiring a PA, a high percentage of patients abandon therapy altogether.

Primary among physician practice concerns regarding the PA process is the sheer volume of time required of practice staff (and sometimes the physicians themselves) to manage the PA process. In addition to completing an initial PA submission, health plans often require additional information (and sometimes a resubmission on a second form), and contacting a health plan can entail long hold times and poor responsiveness. Many staff – in one study, more than 94 percent of Medical Group Practice Managers1 – find it to be a complex and frustrating experience, and highly disruptive to workflow.

“I would recommend PARx to other practices because of time – not having to be on the phone on hold, while a patient in front of me waits for my help,” said Lien Liang, Medical Assistant, Bingjing Roberts, MD, PLLC, New York, NY. “Even when I would be on the phone 30 minutes to 1 hour, it didn’t mean the insurance company would say yes. Often, I would wait 15 to 20 minutes just to talk to a live person. With PARx, it takes less time than that to enter the information online, knowing it is complete, and we’ll often have our answer within 48 hours. During that time, I can track the progress of the PA through the Status page – all together, a very easy system to use.”

PARx provides online training for physician practice staff, backed up by a customer service center staffed with health care professionals including pharmacy techs and nurses. Notes Dan Rubin, President and CEO of PARx Solutions: “Our easy to use technology is just the first step; we provide a high-touch service, with quality assurance that includes speaking directly with insurance companies on behalf of the physician practices and by so doing, saving time and resources for those practices. This is vital to improving PA approval rates; on average, up to 70 percent of PA denials are based on administrative reasons before they are even considered for a medical review.2

PARx Solutions executives are available to media to discuss the current and future Prior Authorization landscape – and what physician practices and pharmaceutical companies need to know to meet the PA challenge. Please contact Ariane Doud, Warner Communications, (978) 283-2674, ariane@warnerpr.com.