How to Make the Prior Authorization Process Better


A new program is looking to give pharmacists and physicians fewer headaches.

Medical Clipboard

Resolving prior authorizations can cost pharmacists time and trigger frustration, but a new program could make the process more efficient.

McKesson Specialty Health has joined with CoverMyMeds, part of McKesson Rx Technology Solutions, to create ExpressCoverage, a patient support platform specially designed to improve the prior authorization process by aiming to increase PA turnaround times, reduce patient abandonment of prescriptions, and reduce administration errors.

"ExpressCoverage allows patients to obtain their prescribed medications more quickly by resolving prior authorizations in the most efficient manner possible via real-time ePA technology," says Regina Murphy, vice president of product strategy for McKesson Specialty Health. "When PAs are resolved quickly, patients are less likely to face hurdles when they arrive at the pharmacy for their prescriptions."

According to Bill Nolan, vice president and general manager of McKesson Specialty Health, what makes the program unique is how it seamlessly integrates into physicians' and pharmacists' existing work flow.

Instead of manually submitting PA forms, ExpressCoverage integrates with the existing CoverMyMeds system that is easily accessible electronically and uses the pharma-sponsored services of McKesson Specialty Health.

Related article: How a New Technology Can Keep Pharmacists in the Front Lines

According to Nolan, physicians will now be able to simply press a button to gain access to a pre-populated form that is then sent on to the support system to secure PA approval.

It's also accessible at the point of sale for pharmacists to make the PA process more efficient. If a prescription is brought to the pharmacy that requires prior authorization, pharmacists can enter into the system, receive the pre-populated form, and then send it to the call center. There, a specialist can confirm they received it, give an estimated time to acquire approval, and seek out any additional information necessary to gain the approval.

"I've expedited it," says Nolan. "From programs I operate, I am able to close that loop probably faster and a little more efficiently than a pharmacist effort in a one-off way and that's the value to the pharmacist."

Nolan says he hopes the program is also able to improve access for patients who may have otherwise abandoned a prescription.

"We all understand that a lot of drugs are prior auth at the point of sale and sizable percentages of those drugs, as a result, are never filled," he says.

ExpressCoverage can not only hopefully capture those patients, but Nolan believes it can also help improve adherence by reducing the barriers to access, shortening the time before patients can begin therapy, and helping patients stay on their therapy for longer.

"We're trying to bring automation where it makes sense, streamline work flow where we can, use our connectivity as a company to repurposing this direction - but we're not doing it as a pursuit or a destination unto itself," says Nolan. "We're doing it because patients are in an ever-increasing way more and more on their own for navigating healthcare and there are woefully few and inadequate sets of tools available to them to make informed decisions." 

Related Videos
© 2024 MJH Life Sciences

All rights reserved.