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

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

Meeting the Prior Authorization Challenge Podcast Series – Staff Productivity

By Dan Rubin, CEO

Now on our podcast page – the second installment of the “Meeting the Prior Authorization Challenge” podcast series! The newest episodes of this free resource cover maximizing optimal staff productivity in the face of a changing prior authorization landscape. PARx Director of Operations and Training Rabia Kabeer is joined by a Nurse Practitioner and a Practice Manager to deliver valuable insights into how PA’s have evolved, the pain points associated with them and how to give your staff the tools to make the most of their already busy schedules.

Topics addressed in this podcast series are:

Episode Four: How is the prior authorization landscape changing?
PARx’s own Director of Operations and Training Rabia Kabeer kicks off the staff productivity discussion by explaining how prior authorizations have changed over the last decade. She also provides an overview of our recent innovation, GUEST PASS, which allows any provider to submit a prior authorization using the PARx Prior Authorization Support System (‘PASS’), without going through the registration process.

Episode Five: Saving time with prior authorizations
Nurse Practitioner Jennifer Gillis weighs in on increasing prior authorization requirements and how the fluid, easy-to-use PASS system has cut the time needed to process them by 20% for her practice.

Episode Six: How PASS improves practice workflow
Practice Manager Kathy Parish explains how prior authorizations previously were complex and hard to keep track of.  Now her practice uses the PARx Solutions platform PASS, streamlining and speeding up the process.

Take a listen, and let us know what you think! Have a topic you’d like addressed in a future podcast? Drop a line to ariane@warnerpr.com with your suggestion and feedback.

Episode Four: How is the prior authorization landscape changing?

PARx’s own Director of Operations and Training Rabia Kabeer kicks off the staff productivity discussion by explaining how prior authorizations have changed over the last decade.

Kabeer also provides an overview of our recent innovation, GUEST PASS, which allows any provider to submit a prior authorization using the PARx Prior Authorization Support System (‘PASS’), without going through the registration process.

Note: This audio player is not supported in Internet Explorer 8 and earlier versions.

Episode Five: Saving time with prior authorizations

Nurse Practitioner Jennifer Gillis weighs in on increasing prior authorization requirements and how the fluid, easy-to-use PASS system has cut the time needed to process them by 20% for her practice.

Note: This audio player is not supported in Internet Explorer 8 and earlier versions.

Episode Six: How PASS improves practice workflow

Practice Manager Kathy Parish explains how prior authorizations previously were complex and hard to keep track of. Now her practice uses the PARx Solutions platform PASS, streamlining and speeding up the process.

Note: This audio player is not supported in Internet Explorer 8 and earlier versions.

3 Reasons Why “Full Service” Matters in PA Management

Healthcare providers today have a range of options when it comes to managing the ever-increasing number of prescription prior authorizations (PA).  They may choose to “go it alone” – searching for the correct submission form, completing the form, submitting the completed form and following up with the plan (often by phone). They may opt to use a “form based” third party service to find and complete the correct form, followed by the burden of follow up with the plan falling on practice staff. Or, they may choose a “full service” PA management partner. I’ve referenced PARx Solutions as the premier full-service PA management partner in past blogs; now, let’s consider what “full service” really means, and why should it matter to providers and their patients?

1. Insurance Verification: I was recently at a pharma client sales meeting when a district manager approached me with a concern about our service. She informed me that one of the practices in her district had tried using PASS (PARx Prior Authorization Support System), but that all nine of the PAs submitted were denied due to “insurance not found.” Upon hearing this, I reviewed all of the PA submissions from the practice, and found that just three submissions were placed through PASS – and all three were approved. As it turned out, the nine denied PAs were submitted using a different service.

This unnoticed error isn’t unusual from a busy practice; we have found that nearly half of all PA submissions cite incorrect patient insurance information, often due to including the medical insurance information rather than the prescription plan. As a full-service partner, PARx calls the pharmacy to confirm the patient’s prescription plan coverage prior to submission, to ensure that the PA is routed to the appropriate plan. This in contrast to a form based provider, in which case the PA is submitted to the wrong plan and so denied for insurance not found – as was the case in this example.

2. Follow-up with the Plan: Plans don’t always act expeditiously with regard to PA submissions. Often, practices need to follow up with the plan to get an answer on a previously submitted PA, or to provide additional information. Calling a plan generally results in extremely long telephone hold times (we have found typical hold times ranging from 10 to 45 minutes) before the staff member has the opportunity to speak with anyone at the plan. Most practices cannot dedicate the resources to sit idly on hold, waiting for the plan to respond to their inquiries.  With a full service partner,  follow up is performed on behalf of the practice, saving significant time for practice staff and resulting in faster PA decisions.

3. Quality of Submission: Plans frequently change the PA requirements for specific medications, as well as the PA submission forms and the process for submissions. This can become confusing for practices and result in more time being spent on the submission process, as well as frequent omissions of key information. Full service PA management partners review all submissions for completeness and accuracy prior to submitting the request to the plan. This results in a higher quality submission, leading to more approvals and better workflow management for the provider.

When considering how best to manage the increasingly complex world of prescription PAs, consider using a full service PA management partner to ensure that more patients receive the medication their provider deems best for their treatment.