Understanding Prior Authorization to Ensure Timely Medication Access

Total Pharmacy JournalTotal Pharmacy February 2024
Volume 02
Issue 01

According to Tyler Milliken, educating providers about prior authorization, along with other insurance processes and policies, plays a crucial role in advancing patients along their path to care.

Many moving parts are involved in the process of gaining access to necessary medical treatment. These include prior authorization, often considered a time-consuming process that can stall a patient's path to care.

At the Healthcare Advocate Summit, Drug Topics sat down with Tyler Milliken, biologics director at North Texas Allergy and Asthma Associates, to discuss insights into navigating prior authorization and critical components associated with ensuring medication access.

“As always, we’re dealing with human error on the other end of the phone, so you want to make sure that you can cover your bases and really feel good about what direction you’re moving forward with before you start prior authorization. Understanding payer tendencies, educating the patient on what that process looks like—timelines, and things of that nature—really goes a long way.”

Educating doctors so that they understand payer policies and processes, Milliken said, is key to ensuring timely medication access for patients.

“Educating your doctors is always okay. Have that open door to be able to speak to them openly about what it is that these payers are looking for. The doctors do want their patient on that therapy, otherwise they wouldn’t have started them.”

According to Milliken, collaboration, like that fostered by events like the Healthcare Advocate Summit, is critical to promote patient advocacy and continue improving processes like prior authorization moving forward.

“Sometimes it’s just nice hearing from another individual like yourself that’s going through the same problem and that has real-time feedback for how we’re going to approach this: [how] are we looking to make changes in our own processes and then confirm that with someone who might be doing something different, and then also meeting in the middle to be a resource for them as well.”

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