“Set it and forget it” – keeping patients on the Rx their provider prefers

By Dan Rubin, CEO

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).

pharmacy-pa-problemsProviders 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.

Death by Prior Authorization

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.

From chaos to clarity: how a PA partner can help practices cut out the confusion

By Dan Rubin, CEO

In the February issue of Primary Care Optometry News, an optometrist who utilizes PARx in his practice was interviewed about his experience with the prior authorization (PA) process – and what best practices he would recommend. “Prior authorizations are here to stay,” Jeffrey S. Williams Jr., OD, Dipl ABO, noted in the article. “Optometrists must learn how to navigate prior authorizations in order for their patients to receive the branded medications they are prescribed.”

Williams, who practices on Long Island, New York, recommends use of a full-service PA process provider to any medical practice struggling with the challenge of PA. His office uses PARx Solutions.

Before adopting the service, navigating PA in his office was messy, Williams said. “It was a lot of blank forms from the 10 different, respective insurance companies that we accept. You’d have to fill it out, fax it and pray that it was approved. If it wasn’t approved, you’d get a 15-page fax back,” he said.

His staff would manage lengthy spreadsheets to keep track of patients, various dates and follow-up milestones. “It was a lot of wasted time and frustration,” Williams said.

Williams outlined how practice owners can assess the impact of the PA process on their practice and weigh the systems available that are intended to help. He wrote that a good starting point is looking at the individual PA process challenges at the practice. These may include:

  • How often are prescriptions denied coverage because a PA is required?
  • Are your patients’ managed care plans frequently changing the criteria for approving coverage for your prescribed medications?
  • How important is it for your patients to receive the specific medication that you originally prescribed?

Next, he suggested appraising the current burden on the optometrist and staff in managing PAs:

  • How many hours are spent on PAs including: hunting down the correct form, completing and submitting the forms and spending time on the phone with managed care plans?
  • How often are submitted PAs denied by the plan?
  • If denied, how often does your practice appeal the decision with the plan?

Finally, he suggested considering the PA process options: using a form-based service, or ideally, a full-service provider, per his experience with PARx.

Providers also have the option of going it alone, which Williams says may require a member of the staff focusing solely on PAs or carving out time from multiple staff members. After using the service, not only are approvals accomplished faster at his office, but through the experience, his staff has learned many of the protocols for the different insurance requirements.

“It went from chaos and confusion and shooting in the dark to seeing more patients daily,” Williams said of his practice’s transition to full-service PA provider PARx Solutions.

The above is excerpted from an article appearing on Healio.com. To read the complete article, please go to: https://www.healio.com/optometry/therapeutics/news/print/primary-care-optometry-news/%7B62e366db-cf6b-4049-807d-502eec4b17ad%7D/clinicians-provide-best-practices-for-helping-patients-access-medications?page=1

Closing The Loop on Patient Engagement: Overcoming the PA Washout

By Dan Rubin, CEO

As pharmaceutical marketing has evolved from “selling pills” to assuring that medications actually get dispensed and taken by patients, many brands have layered patient engagement and support programs into the marketing mix to assist with a range of issues including patient education, therapeutic support, benefit verification, financial assistance, and adherence support. Many brands utilize a patient support program (sometimes referred to as a “patient hub”) as a single point of contact for patients to access these support services online or via 800 numbers. Beyond receiving general product/condition education prior to therapy initiation, patients frequently use these support programs to verify insurance coverage, understand whether prior authorization is required, obtain co-pay cards, or explore the potential availability of Medicare tier exceptions.

While patient support programs often claim to address patient access issues such as PA, they usually fail to result in high physician submission and approval rates. After performing a patient-specific benefit verification and determining that a PA is required, the typical action is to fax a PA form to the prescriber. Similarly, if the patient is covered by Medicare and might be eligible for a lower co-pay from a tier exception (TE), they typically fax the Medicare Coverage Determination form to the practice. In either case, practices frequently do not follow through on the PA or TE request due to the burdensome submission and follow up process required by the managed care (or Medicare) plan. As a result, the PA doesn’t get submitted and the patient gets switched to an alternative therapy or abandons treatment altogether.

One brand utilized an innovative program to drive more prescriptions by integrating a full-service PA support program based on the result of their benefit investigation. Prior to implementing this new program, the brand reported that physician PA submission rates were very low and when a PA was submitted, approval rates averaged around 50-60 percent.

Results. After implementing the new program, the brand saw significant increases in both PA submission and approval rates. Physicians submitted PAs more than 50 percent of the time after receiving a notification from the service provider. Over 42 weeks, physicians submitted a total of 952 PAs independently (without receiving any notifications). After receiving notifications, physicians submitted an incremental 4,967 PAs, with a 75 percent average approval rate.

Overall, the program resulted in nearly 4,000 incremental approved PAs, which translated into approximately 10,000+ incremental TRx’s. The brand’s return on investment in the program was sixteen to one, and more importantly, approximately 4,000 patients ended up receiving the medication their physician deemed best, instead of a substitute therapy or abandoning therapy altogether.

When left on their own, many practices will not deal with the cumbersome process of completing and submitting PAs. A service that makes this process more streamlined and less time consuming for physicians and their staff will lead to higher PA submission rates and more prescriptions dispensed.

Many pharma brands have already created patient support programs that address patient coverage issues.  Adding an effective PA service can be a small incremental step that yields large benefits from more patients on therapy, less physician frustration, and fewer prescriptions being substituted or abandoned.

The above is excerpted from an article by Dan Rubin, President and CEO, PARx Solutions, appearing on PharmExec.com. To read the complete article, please go to: http://www.pharmexec.com/closing-loop-patient-engagement-overcoming-pa-washout.

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

Reflecting on 2017, Looking Ahead to 2018

By Dan Rubin, CEO

Happy New Year to everyone!  As people often do, when a year ends, I like to reflect upon the accomplishments of the past year while looking forward to the great things ahead in the coming year.

2017 was a banner year at PARx Solutions.  The company continued to grow in both prior authorization (PA) volume and clients.  PARx assisted more physician practices with their PA support than in any previous year.  We added new capabilities in our PARx Prior Authorization Support System (PASS) system and launched new services to better support patients, physician practices and our pharmaceutical clients.

Why are more and more pharmaceutical clients and physician practices choosing PARx as their partner to assist with PA management and support?  From a pharma perspective, we have seen more brands abandon their previous “forms based” PA service as they realize that simply sending a PA form to a physician does not ensure that the PA will be submitted.  Several clients commented that they were no longer interested in paying for PAs that are never submitted to plans.

Physician practices are learning that the PA process often doesn’t end when the initial form is submitted to the plan.  Many plans send back second patient-specific forms to be completed.  Follow-up calls to plans to check status often result in long telephone hold times.  In general, practices have come to appreciate the full-service approach to PA management offered by PARx.

PARx launched several new enhancements to our PASS system in 2017.  Early in the year, we introduced our group practice log-in credentials, enabling a designated registrant from a group practice to submit PAs for any physician in the practice under a single user log-in.  At the same time, we simplified our registration process, allowing new users to register and electronically sign their HIPAA business associate agreement at the same time.  In the summer, PARx launched Guest PASS, enabling any physician to submit PAs through PARx Solutions, whether they were registered on not.  We also added a “Chart Upload” feature that makes it much easier to include supportive information from the patient’s medical record.

In 2017, PARx offered our new “PA Card” service.  This new service works in partnership with coupon card providers to identify new Rx’s filled with the assistance of a coupon card but where the primary insurance requires a PA.  In these cases, PARx notifies the prescribing physician that their patient will require a PA in order to get their refills covered by their plan, and provides a unique code where the physician (whether registered or not) can access a partially completed PA for that patient in PASS.

With 2017 in the rearview mirror, we are excited about what is in store for PARx in 2018.  We expect to continue to add new capabilities and services to support our physician practices and pharma clients.  By mid-year, PARx will introduce our new electronic PA (ePA) capability.  The PARx ePA service will be a unique “hybrid” service offering both speed and convenience for PA submissions to plans that are “ePA ready,” while continuing to provide our high level of full-service support for submissions to plans that are not yet equipped to handle ePAs.  This whole process will be “invisible” to physician practices as they will simply access all their PAs through our PASS portal as they have done in the past.  We are confident that our approach to ePA will set a high standard for PA support in the industry.

As always, I want to thank all of our physicians, their staff, and our pharmaceutical clients for their support and I look forward to working together in 2018 and beyond.