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

The Year Ahead: What’s On the PARx Horizon

By Dan Rubin, CEO

2017parx

“Listen to the voice of the customer.”  It is an age-old business adage and one that the best companies always take to heart.    Over the past several months, we have had discussions with dozens of physicians and their staff to understand how our service can help them save even more time, produce higher PA approval rates, and most importantly help their patients get the therapy that is best suited to treat their conditions.  When customers speak, we listen!

We are excited to announce several enhancements to our PASS system – many created in response to feedback from physician practices utilizing our PASS service –  that we will be rolling out in the first quarter, including:

  • Single-User, Multi-Physician log-in: Group practices will be able to designate PASS users who can submit prior authorizations (PAs) for multiple physicians in the practice under a single log-in.
  • Chart note uploads: Users will be able to upload chart notes directly into the PASS submission, eliminating the need to print and fax these separately.
  • Electronic signatures: Prescribers will be able to register for PASS and electronically sign their HIPAA Business Associate Agreement, enabling them to register and immediately begin to submit PAs.

PARx continues to add new sponsored products to our roster.  For example, we  have added new brands to our already comprehensive list of eye care products covered, and are significantly strengthening our roster of covered products in several other therapeutic areas including diabetes, GI, weight loss, and dermatology to name a few.

PARx is in discussions about partnering with multiple Electronic Medical Records (EMR) providers.  Our goal is to enable registered PASS users to initiate PAs from within their EMR, pre-populating the PA submission with information from the patient record.  For some large group practices, PARx will be fully integrating with their EMR to provide the most efficient and comprehensive PA service in the market today.

We highly value the trust that our users have placed in PARx, and we constantly strive to improve on our market-best PA service.  I would like to personally thank all of our users and wish each of you a happy and healthy holiday season and new year. We look forward to 2017 with enthusiasm!

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

ODs get assistance with prior authorizations for prescriptions

Primary Care Optometry News, November 2016

Optometrists say they are providing better patient care by using a prior authorization service that facilitates patients receiving insurance coverage of necessary medications.

PARx Solutions’ free support system helps prescribers and their staff process prior authorizations (PAs) without having to call insurance companies and search for forms.

“For a practitioner, prior authorization is a frustrating and burdensome process,” Dan Rubin, PARx Solutions president and CEO said in an interview with Primary Care Optometry News. “We are trying to make sure patients can get the medication best suited to treat their condition. We want to remove hurdles and give doctors power and confidence to write the prescription and have a strong likelihood that patients can get the medicine.”

Harvey Richman, OD, FAAO, FCOVD, a PARx user and private practitioner from Manasquan, N.J., told PCON that this service helps him make better clinical decisions.

“You can request prior authorization in under 3 minutes, which gets medications to patients sooner,” he said.

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.

Meeting the PA Challenge: A prescription for patients and 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.

 

Create a Process to Expedite Prior Authorizations

Dr. Richman, owner of Shore Family Eyecare in Manasquan, NJ, reviews his prior authorization management process, featuring PARx as the preferred technology solution. The article discusses how PARx cuts processing time down by as much as 70%.