Tackling the Prior Authorization Challenge: A Critical Task for Pharma

Pharmaceutical Executive | Dan Rubin | May 4, 2017

our-solutionsTalk with busy physicians and you’ll soon hear about the ever-increasing difficulty in getting approval for the medications that they believe are most appropriate for their patients. For pharma marketers, a superior efficacy, side effect and dosing profile is a necessary start, and a favorable managed care formulary position can be another positive step toward commercial success—but, more and more frequently, a prior authorization (PA) request must be approved before a medication can be dispensed and taken by the patient.  Read Article

Pharmaceutical Representatives: Tips for Building Strong Physician Practice Relations

By Dr. Charles Gold, Optometrist, New York, NY

Doctors Shaking Businessperson Hand

When a pharmaceutical representative enters my office, I expect one thing: that they add value to my practice. Working with a pharmaceutical representative is all about building a relationship. We want to feel that you know our practice and our staff. We want to see that you have something to offer us – beyond free samples. For any pharmaceutical representative looking to better their physician practice approach, here are my top two tips:

Get to know the staff. Too often, pharmaceutical representatives walk into an office and head right for the doctor. The is not the right approach at all! Instead, take some time and get to know the practice staff. Be sure to write down every staff member’s name and maybe even a brief description if it will be helpful for you.

Then, the next time you visit the doctor’s office, review your notes and make a point of using their names in your conversations. This will go a very long way in standing out and making an impression on the people who work very hard – and are often the individuals entering the prior authorizations (PAs) for your prescriptions!

Be helpful and offer advice. This can be as simple as reviewing the office’s website or as detailed as providing a new vendor service to the office.

Consider this: it is becoming more and more difficult to run a practice, and prior authorizations are definitely among the time-consuming challenges we face.  If you offer a value add – such as a prior authorization service vendor – you’re likely to catch the office’s attention. Doctor’s offices are going to favor companies that work with PA service providers like PARx. They’re easier to deal with. They make getting PAs approved easier and quicker. And they help us keep our patients happy!

Plus, by offering a PA service provider, you as a pharmaceutical representative are opening the door to new information. Some of the best reps I see in my office are the ones who come in, say hello to my staff, maybe bring lunch, and check in to see how PAs are progressing in the office. Are they being approved? Which medications are most denied, and what are the common reasons given? By reviewing this information, the reps are able to learn more about our practice, They are able to offer insight and prove their worth to both me and my staff.

Today, in order to be truly successful in establishing a relationship with a physician practice, pharmaceutical representatives must add value!

Prior Authorization: Minor Inconvenience or Threat to Pharma Viability?

Pharmaceutical Processing | Dan Rubin, CEO | December 1, 2016

Tackling the Prior Authorization Challenge

The commercial dynamics facing the pharmaceutical industry have shifted in recent years.  It is no longer sufficient to market pharmaceutical products based solely on efficacy and side effect profile, or to contract with managed care for formulary positions. It has become vitally important for pharma to help physicians navigate the complex maze of patient access due to managed care restrictions, in order to help patients receive the best treatment for their condition.  Read the full article

Getting the Prescribed Medication to the Patient: Prior Auth and the Pull-Through Challenge

By Dan Rubin, CEO

Cooperation conceptIt’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.