It can feel all too familiar. A patient visits your practice, you prescribe a drug to treat their condition, and they go to the pharmacy to pick it up. However, when they arrive, they find out that the prescription is not ready because it cannot be filled without the extra step of prior authorization (PA). The pharmacy and patient phone your office, and you and your staff spend time calling, faxing, and pleading with the payers (i.e., the health insurance companies) to satisfy the PA guidelines. This can add hours, days, or weeks to the process of getting the prescription.
Time is money
This is time-consuming for you, and it’s frustrating for patients. And while PAs may bring cost savings to payers, it can bring expense to providers and practices that must divert resources to address this issue. Consider that the average physician:
- Spends time on 35 authorizations per week
- Spends 20 hours a week on PA activities
- Is rejected by payers 20% of the time on initial PA requests
- Spends $83,000 per year interacting with insurance plans
While getting the patient the needed prescription is crucial to treatment, many physicians feel this extra time spent can undermine patient care, as less time is spent on patient interaction. PA can also limit access to certain medications. In some cases the only one that can adequately treat a patient’s condition is not authorized.
Rx for success
Fortunately there’s a prescription for this problem. Electronic prior authorization (ePA) platforms can be integrated directly into the doctor’s electronic health record (EHR) system to alert the physician when they don’t provide the needed documentation for a PA. Physicians can get a real-time PA response before the patient even leaves the office.
How does it work?
- Physicians are presented with patient and health plan-specific questions automatically
- Patient data are prepopulated, eliminating the need to complete PA forms manually
- All requests are sent directly to the health plan electronically, eliminating the need for faxing and phone calls
- The ePA integrates directly with the e-prescribing workflow, eliminating the need for users to leave the EHR platform
The ePA simplifies the manual PA process by drawing upon benefits data from 225 million insured patients. During the e-Prescribing process, the physician is notified of PA requirements and can either select an alternate medication or submit authorization to the PA immediately within the EHR. The authorized script is sent to the pharmacy, and the pharmacist is able to fill the prescription. The patient picks up the prescription without delay.
Manual PA is complex and time consuming.
Electronic prior authorization simplifies the PA process.
Physicians shouldn’t have to spend so much time on PA. Read the white paper, “Demystifying Electronic Prior Authorization (ePA)” to learn how Care360’s EHR can help you achieve PA.