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.
Pharmaceutical Executive | Dan Rubin | April 24, 2019
I recently read news that really brought home the real-life impact on patient care —really, on patient’s lives—of an effective prior authorization (PA) process. In February 2019, long-time disability rights activist and attorney Carrie Ann Lucas died prematurely at age 47 from a plethora of health problems, exacerbated by her disabilities.
However, according to a post following her passing on her Facebook page, her friends and family identify the root cause as the denial by her insurance carrier of “the one specific inhaled antibiotic that she really needed. She had to take a less effective drug and had a bad reaction to that drug. Read the full article.
Pharmaceutical Executive | Dan Rubin | September 21, 2018
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
Pharmaceutical Executive | Dan Rubin | March 28, 2018
For 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