At an increasing rate, prescriptions are being denied
Physicians utilize extensive clinical experience when deciding which medication is right for their patients. Yet, more and more of these prescriptions are being denied by patients’ managed care plans – mandating that the prescribers successfully navigate the “prior authorization” process in order to ensure that their patients receive the treatment of choice.
Prescription PAs are disruptive to providing timely care
Prescription prior authorization is disruptive for prescribers and pharmacies alike. For prescribers, the process involves several steps that entail spending significant amounts of time on the phone with managed care plans (or worse…on “hold” waiting for the plan). Once the process is complete, studies have shown that these PAs are frequently denied by the plans for simple administrative reasons, without having the benefit of a clinical review.
The PA process is complex and time consuming
The PA process can be very disruptive to a pharmacy’s workflow. When a prescription requires a PA, pharmacists often need to make several phone calls to the prescriber and/or the plan just to initiate the PA process. Once initiated, pharmacies are generally “kept in the dark” about the disposition of the PA – needing to adjudicate the claim multiple times to see if the plan approved the medication.
As a result, patients often end up with sub-optimal medication therapies, or abandon their therapies altogether.
PA PROBLEMS ARE GROWING
40% Abandonment
Meta analysis of pharmacy claims data indicates that when a prescription is rejected due to prior authorization, patients end up with the intended medication only 30 percent of the time. Furthermore, when confronted with the challenge of prior authorization, patients end up abandoning therapy altogether up to 40 percent of the time.
Average of 4.6 hours/week devoted to PAs
A study by CVS/Caremark indicated that physician offices spend on average 4.6 hours per week dealing with prescription prior authorizations.
Prior Authorization requirements are increasing
More and more prescriptions are being denied by plans – requiring prior authorization. In a study by the Kaiser Family Foundation, the percent of drugs in Medicare Prescription Drug Plans which required some form of managed care utilization management restriction grew from 18% in 2007 to 36% in 2012.
THE PARx SOLUTION
Since the company’s inception in 2008, PARx Solutions has successfully helped prescribers easily and quickly initiate and manage the PA process. PARx has a track record of generating consistently high PA approval rates for the products we support.
While providing a PA form to a prescriber is a first step to help manage PAs, PARx has found that consistently strong results require a higher level of service. The PARx approach ensures that the:
- Prescriber submits the PA request
- PA submission is accurate and complete
- Plan responds in a timely manner and
- Follow-up is provided when the plan requires additional information or the prescriber desires to appeal a decision.
Our streamlined process incorporates a web-based portal using our proprietary universal format, along with our call center staffed by healthcare professionals and reimbursement specialists to work directly with prescribers and their staff.
PRESCRIBER SOLUTIONS
Help patients receive the medications that their clinicians deem to be best suited to treat their conditions – without the hassle that PAs create. PARx Solutions’ free Prior Authorization Support System (PASS) helps prescribers and their staff process PAs without having to search for forms or deal with frustrating and time consuming calls with managed care plans.
GUIDE TO A SUCCESSFUL PA PROCESS
Prescribers are finding it increasingly difficult to prescribe medications they deem best for their patients due to prior authorization challenges. Securing an effective PA service can be a key step in navigating the complex PA landscape. Check out our free eBooklet to get started in selecting the right PA service for your practice.