Several years ago, while bored on a Saturday afternoon, I was “channel surfing” on my television and saw an infomercial for a rotisserie oven. The spokesperson, Ron Popeil, repeatedly used the tag line, “just set it and forget it” to show how easy it was. While “set it and forget it” may work when making rotisserie chicken, it does not usually get the job done when it comes to prescription prior authorizations (PA).
Providers may go through the process of completing and submitting a PA when writing the initial new prescription (NRx) for a patient. However, most PAs are approved by the plan for twelve months or less. If the prescriber has written a medication for chronic conditions, this means that the patient will not get coverage after the PA expires unless a second PA is submitted. For many of these patients, it is appropriate to continue therapy for several years. At PARx, we have found that providers resubmit PAs for their patients upon expiration only 5 or 6 percent of the time. This presents a tremendous opportunity for patients, providers, and pharma brands.
Earlier this year, PARx launched our reauthorization program. For interested sponsors, PARx provides notifications to providers a few weeks prior to a PA expiration. The notification informs the provider that a PA has been initiated in the PARx PASS system and directs the provider to complete and submit the partially completed PA. By making the reauthorization process simple for providers, this new program has produced spectacular results to date:
Upon receiving notification from PARx of the expiring PA, 50-60% of providers resubmit a PA request.
The PA approval rate for these second submissions is averaging 96 percent. Compared to the 5-6% submission rate without notification, this program creates thousands of additional prescriptions for our sponsor brands.
More importantly, patients are able to continue on their chronic therapy without interruption.
When it comes to PA, providers who work with PARx can “set it and forget it,” thanks to a timely renewal reminder – and rest easy knowing their patients will continue to have access to the Rx they deem best for their treatment.
As part of our dedication to providing physician practices with the insights they need to lessen the impact of PAs on office workflow and most importantly, to better ensure that patients received the medications their doctors deem best for their treatment, my colleagues and I have unveiled a free podcast series entitled “Meeting the Prior Authorization Challenge: A Prescription for Patients and Physicians“. The series consists of short, insightful conversations with members of the PARx Solutions team, doctors, and practice staff.
Prior authorizations aren’t going away, so it is essential that physician offices empower themselves to better handle the process. Who better to hear from on PAs than doctors and practice managers managing this process on a daily basis? By giving a voice to their frustrations, we hope to raise awareness of the solutions PARx offers at no cost to physician offices.
Topics thus far addressed in the podcast series include:
Episode One: What is PARx Solutions, and why do I need it?
Yours truly launches the podcast series by explaining what prior authorization are and the challenges they raise for physician practices. I also provide an overview of the service provided by PARx Solutions is and how it helps improve practice workflow and patient access to prescribed medications.
Episode Two: Prior authorizations and ophthalmology
Ophthalmologist Dr. Bingjing Roberts weighs in on the importance of prior authorization within her line of medicine and highlights how working with a PA provider has been helpful in ensuring her patients receive the prescriptions they need.
ROCHESTER, Mich., April 18, 2017 (GLOBE NEWSWIRE) — OptimizeRx Corp. (OTCQB:OPRX), the leading digital health aggregator of sponsored services in the electronic health records (EHR) space, has partnered with PARx Solutions to allow more than 500,000 healthcare providers in the OptimizeRx EHR network to manage the prescription prior authorization process more effectively and efficiently. Read Article
It’s no secret that pharma promotion doesn’t come cheap. Between face-to-face promotional activities, free samples, and educational meetings, pharmaceutical companies spend over $15 billion in marketing to physicians each year. That on top of the $5 billion spend on direct-to-consumer advertising means a hefty investment in generating awareness for their drug. And these numbers do not even account for the money spent when developing new products for treating specific conditions and improving patient lives!
Promoting the drug is only a first step toward product usage and generating sales. The positioning, messaging, audience targeting are critical, but moving from promotion to prescribing to ensuring that the patient actually receives the drug is where pitfalls arise for pharmaceutical companies. All of the sales and marketing spending is for naught without patient “pull-through” – the actual, successful picking up of a prescription from the pharmacy.
So what can pharmaceutical companies do differently in the coming year to better ensure pull-through? For starters, pharma can begin to more actively address the growing Prior Authorization (PA) challenge.
PAs are a requirement put in place by a patient’s health plan to approve a specific medication before it can be dispensed. Of the 20 most advertised drugs in 2015, almost all require PA across health plans. Often times, PAs are a road block to a successful prescription. They are a headache and resource drain for physician practices, and result in lost sales for pharmaceutical companies.
When reimbursement is denied for a prescription, the patient likely will not receive the drug that their physician originally prescribed. In fact, approximately 70 percent of patients encountering a PA do not receive the originally prescribed medication, and upwards of 40 percent of those patients forego treatment altogether.
Many pharma companies believe that it’s just a matter of putting a PA form in the hands of the practice, but fewer than half of these forms ever get submitted. A successful pull through strategy not only provides the PA form to the practice but offers a service that increases the likelihood that the form gets completed and submitted to the plan. Implementing an effective and efficient PA service can often overcome the PA challenge and generate real results for pharmaceutical companies. Here’s one of my favorite examples of the impact that a strong pull-through strategy can have: I was recently in touch with a pharmaceutical representative at a major company. She shared that by providing her physician practices with access to the full-service, user-friendly prior authorization support system (PASS) from PARx Solutions, she moved from being her company’s #141 (out of 150) sales rep to their #6!
In another conversation, I connected with a District Manager in a different company whose district is ranked #1 in sales. When inquiring on how she did it, she attributed her success to being the #1 district in the company for PA submissions through PARx PASS.
In 2017, a pull through strategy will be necessary to meet the PA challenge to ensure medications are ultimately dispensed. Successful pull-through strategies must address the hurdles that health plans have put in place, making the process of managing PAs fast and easy for physicians.
Welcome to PASSing Thoughts, a series of expert insights into the prior authorization landscape, from the desk of Dan Rubin, President and CEO of PARx Solutions, the creators of the PARx Prior Authorization Support System (‘PASS’).
At the point of prescription, when physicians are choosing the medication they deem best for their patients, doctor and patient are on the same page. Patients want the treatment that can best address their condition with a successful health outcome and minimal side effects. They are relying on the expertise of their physicians, who are trained to make the clinical decisions as to the best treatments for their patients’ conditions. Seems to be a simple equation, right?
Unfortunately, there are roadblocks. In many cases, patients end up not being treated with the specific medication that their physician had prescribed.
One of the main reasons for this problem is that managed care plans are putting restrictions in place, often based on economic considerations rather than clinical benefits. In particular, a growing concern for physician practices is the need for prior authorizations (PA) – the requirement by a patient’s health plan to approve a specific medication for reimbursement, without which, many patients are unable to fill the prescription.
PAs have real impact on patients receiving the medication their physician deems best for their treatment: data suggests only 29% of prescriptions that require PAs are dispensed with the originally prescribed medication, and that only 60% are filled with any medication.
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 or a resubmission of a second form. Then, when trying to contact the health plan directly, practice staff often experience long hold times and poor responsiveness. Many staff find the process to be a complex, frustrating experience and highly disruptive to their workflow.
Physicians utilizing the right PA service end up with more patients receiving the originally prescribed medication for their conditions and less administrative time spent on non-clinical activities in their practices. The “right” PA service is one that goes beyond simply providing a form to the practice. It is one that streamlines the process for the prescriber, provides a standard electronic PA process that eliminates the need to complete specific insurance forms, reviews PA requests prior to submission, follows up with the plan for a timely response, contacts the prescriber when additional information is required, manages appeals if required, and offers access to a call center staffed by responsive and well trained nurses and pharmacy technicians.. And last but not least, it is a service that provides this help and insight at no cost to the physician practice.
When the right PA service is employed, everyone wins: physicians, practice staff, and most importantly, patients.