Improving Prior Authorization

A necessary step in the healthcare benefits process that is often clouded in frustration is prior authorization. In an effort to promote safe, proper prescribing and also to reduce the overall cost of healthcare, this extra step of approval is often employed by insurance companies, pharmacy benefits mangers (PBMs) or third party administrators (TBAs) before a prescription is ever handed to the consumer. While the intentions are good, the actual practice of prior authorization can result in extra time and, as a result, extra money.

According to the Journal of The American Board of Family Medicine, prior authorization activities can cost physicians upwards of $3,430 a year, especially if doctors use self-reporting methods for prescription claims. In addition to the costs to physicians, prior authorization is also costly for patients, who often find themselves sidelined by the process when they arrive at their pharmacy.

While essentially unavoidable, there are ways PBMs and TPAs can reduce the frustrations and costs associated with prior authorization, optimizing the process to benefit everyone involved. Many physicians are being encouraged to work with payer’s websites rather than through the phone, meaning that prior authorization processes need to be as modern as possible. They should also be very straight- forward and user-friendly, allowing doctors to make certain they’ve met all requirements for prior authorization before prescribing a drug.

In order to achieve this higher level of efficiency, utilization of electronic prior authorization is crucial. By streamlining the connection between PBMs or TPAs, the physician and the point of sale pharmacy, overall labor costs can be reduced with faster submissions, reviews and determinations. Structured reporting of timelines for all prior authorization processing activities can also help physicians reduce potentially costly compliance audit issues.

By utilizing advanced technology and mHealth concepts such as RxEOB’s AUTOAUTH RX® application, prior authorization can become an entirely electronic process, making it much more efficient. To find out more about improving the overall prior authorization process, contact RXEOB today.