How to Save Money and Time by Simplifying Prior Authorization

As a pharmacy benefits manager (PBM) or health care provider, you’re always looking for ways to improve your members’ experience with health care delivery and potential save money for your plan sponsors. One way to do this is by offering network physician’s easier prior authorization (PA) for prescriptions at the point of care. Prior authorization ensures that the drug being prescribed is not only safe and being used for the correct health condition, but that the patient’s formulary and benefit plan design are being considered at the point of prescribing

 

Relieving the Burden of Prior Authorization

 

While prior authorization isn’t meant to be a burden, in reality it can be frustrating and time consuming for everyone involved. For example, physicians and patients don’t always know what drugs are on a plan’s formulary. If the physician prescribes a medication off of the patient’s formulary or plan design,, often the only way they find out is when the consumer is at the point of sale in the pharmacy. When this happens, often a time consuming back-and-forth process between the pharmacy and the doctor’s office occurs. This is not only frustrating to the medical professionals involved, but also to the patient who just wants to get their medication. Research suggests that prescription abandonment becomes more likely if the PA process interrupts the process of delivering the medication to the patient at the retail pharmacy.*

*http://www.policymattersjournal.org/krieger.html

 

Delays are often experienced on both the patient and practice side even when the prior authorization process works efficiently. For physicians’ staffs alone, the PA process can cost as much as 20 hours per week.

 

Cut Costs, Reduce Delays and Ease Compliance Audit Hassles

 

So how does our industry find the balance between the benefits and the hassles? One way is to reduce costs for both physicians and plans/PBMs through a program like AutoAuthRx™, which allows for e-PA submission, review and determination between a nwtwork physician and the clinical pharmacy of the payer or PBM In addition to speeding up time via online processing, such a system can:

 

• Give the provider the therapeutic options for the patient based on their unique formulary and pharmacy benefit design
• Reduce delays at the point of sale/pharmacy and increases adherence with prescribed medications
• Decrease processing costs, creating a higher margin for plans/PBMs that charge for PA service
• Reduce compliance audit hassles by providing structured reporting of timelines for all PA processing activities

 

Reporting, Collaboration, Communication

 

Structured reporting is central to the AutoAuthRx™ system. In addition to offering timelines for all prior-authorization processing activities, it also provides information about members, displays a database of drugs and their required criteria for authorization, and shows an overview of drugs that have been previously approved.

 

This depth of data enables all parties – physicians, plans/PBMs and patients – to communicate clearly in real time about the prior authorization process, saving time, money and frustration.

 

If your plan or PBM is interested in learning more about streamlining the PA process with AutoAuthRx™, contact us today at info@rxeob.com, or by phone at 888-648-0989 ext. 226. We can help you not just play, but win the PA game.