Closing The Loop on Patient Engagement: Overcoming the PA Washout

Pharmaceutical Executive | Dan Rubin | September 21, 2018

prescriber-solutions

Pharma brands invest heavily in sales and marketing tactics aimed at convincing physicians to prescribe their product. Even when successful, these efforts represent only a first step in realizing more prescriptions that actually get dispensed. Particularly when a prescription requires prior authorization (PA), retail pharmacy data shows that the originally prescribed product ends up being dispensed less than thirty percent of the time.  In two-thirds of cases, the medication is either switched to another product or abandoned altogether, leaving both patients and physicians frustrated. PA requirements are being implemented by payers for more brands across most therapeutic categories, so the negative impact on pharma continues to deepen. Read the full article

Good News for Specialty Practices – PARx Solutions Expands Partnership with ZappRx

By Dan Rubin, CEO

Recently, PARx expanded our partnership with ZappRx, a healthcare technology company that reduces the administrative burden associated with prescribing specialty medications. As of June 2018, ZappRx users  – which range from large academic medical centers to small, independent physician practices – can access PARx Solutions’ prescription prior authorization services across all treatment areas supported on the ZappRx platform. This is especially good news for practices in Gastroenterology, Rheumatology, Cardiology, and Neurology, broadening their ability to significantly shorten the prior authorization timeline. ZappRx leverages our PASS (prior authorization support system) to alleviate the administrative burden for medical practices.

As I noted in the announcement of this expanded partnership, since the beginning, ZappRx and PARx Solutions have been very complementary. We believe that ZappRx offers specialty drug prescribers a comprehensive solution that makes it dramatically easier for physicians to combat and treat complex diseases. Together, we have been tremendously successful in the past 18 months within the Pulmonary Arterial Hypertension (PAH), Idiopathic Pulmonary Fibrosis, and Cystic Fibrosis (CF) therapeutic categories, adding support this year for Congestive Heart Failure and Hyperlipidemia. We are excited to extend our joint solutions into new therapeutic categories, which will immediately and dramatically increase the number of lives we can positively impact.

And it’s already working: according to a ZappRx’s pre-implementation survey results, physicians who prescribed specialty drugs experienced PA approval rates below 75 percent before using the integrated ZappRx -PARx approach, In contrast, the ZappRx-PARx solution has produced approval rates of 95 percent, with approvals secured in a matter of days, not weeks, even for complex conditions such as PAH.

At a recent launch of the ZappRx Platform at a prestigious academic medical center, prescribers were thrilled to have the first PA submitted through the Platform approved the same afternoon.  ‘The clinical staff was so surprised at the quick turnaround, that they actually reached out to our team to see if we were playing a joke,’ said Karen Tirozzi, Vice President of Solutions at ZappRx.  PARx is excited about continuing to expand our partnership with ZappRx and look forward to providing PA support services to new health care organizations and physicians who choose the ZappRx platform for their specialty drug prescribing support.

Prior Authorizations, Practice Management and Patient Care: an Optometrist Shares his Insights

By Dr. Jeffrey Williams

I’m not alone in my assessment of the prior authorization (PA) process as a significant burden for physician practices: according to a 2017 American Medical Association (AMA) Prior Authorization Physician Survey,1 a medical practice completes an average of 29.1 PA requests per physician per week, which takes an average of 14.6 hours to process, or nearly two business days.

The PA burden is currently a reasonable one for my staff and I, but that wasn’t always the case. When we handled PAs ourselves – specifically, I handled many submissions personally – the process had a significant, negative impact on practice management and on patient care.  No matter how well I kept up with the forms specific to each patient’s insurance plan, their condition, and the medication brand, I’d often find myself facing a denial and so having to get on the phone with the plan. This invariably meant at least 45 minutes on hold – sometimes that long just to reach a person, and not always the right person at that, and with no guarantee I’d be able to turn the denial around.  Critical delays were common, and absolutely impacted patient care – for example, I often prescribe Restasis for chronic dry eye, for which there really isn’t an equal substitute, and which requires a PA under most plans.

When PAs are denied, this means my patients aren’t receiving the medication I’ve deemed best suited to treat their condition, which in turn impacts clinical outcomes. I’ve since changed how my practice handles PAs – I now submit via the PARx Solutions portal, knowing I’ll be provided with the right form and that most importantly, as a full service provider the PARx team will work with my patients’ plans on my practice’s behalf. Unlike PA services that provide just the forms, their team of qualified healthcare professionals call the plans (and wait out the inevitable hold times), work with my staff to provide any additional information that is required, and overall greatly increase the potential for approvals.  Submissions take an average of 5 minutes to complete, and we usually have a final answer from the plan within 48 hours.

My practice management has improved, my patient care has improved (both in terms of being better able to get the medications I prescribe to my patients, and in the additional time I now have to spend with my patients), and overall, I’d recommend this approach to any medical practice.

Dr. Jeffrey Williams is an Optometrist with Sound Vision Care, Inc. of Long Island, NY. A graduate of The Ohio State University, he is Board Certified by The American Board of Optometry and The National Board of Optometric Examiners. 

  1. 2017 AMA Prior Authorization Physician Survey. 2018. Chicago: American Medical Association. Accessed April 16, 2018 at https://www.ama-assn.org/sites/default/files/media-browser/public/arc/prior-auth-2017.pdf.

Generating High PA Approval Rates: Important But Not Sufficient

Pharmaceutical Executive | Dan Rubin | March 28, 2018

pharmacy-pa-problemsFor many pharmaceutical brands, managed care restrictions put tremendous pressure on the ability for patients to access prescribed medications, even when their physicians deem a particular medication to be best suited to treat their condition. To combat this challenge, many brands have engaged third parties to implement programs designed to assist physician practices with managing the cumbersome prior authorization (PA) process. While these programs may help generate higher PA approval rates, this metric alone is insufficient in evaluating whether the program is truly beneficial to patients and impactful for the sponsoring brand.  Read the full article