Strategies to help you and your patients save time and money
By Kimberly K. Friedman, OD, FAAO
How much time do you spend on prior authorizations (PAs)? When I started practicing in 1991, I had never heard of such a thing, and now PAs are a part of our everyday existence as independent eye care professionals. My practice now employs a technician whose primary responsibility is handling these transactions — a huge expense in time and salary for something that is really a function of pharmaceutical insurance, for which I’m not compensated. How frustrating!
Here are lessons I’ve learned over the years for how to manage that endless pile of prior authorizations effectively. I’m sure we can all relate.
- Befriend your pharmaceutical representatives
These reps know their drugs, and they know how to get them covered. Every time a drug rep comes into the office, I make sure he or she meets with my PA technicians. I don’t know the details of what needs to be done to get a drug approved, but the drug reps do. Maintain constant communication between drug representatives and PA technicians to facilitate a smooth authorization process.
- Create a list of substitutions that your PA technician can automatically authorize
In determining the breadth of this list, you will need to consider your personal medical decision-making comfort level. For instance, I have established a protocol for my technicians to follow in the event a patient on a name-brand prostaglandin analog requests a generic alternative. Having this protocol in place means that the technicians don’t need to come to me each time there’s a call from the pharmacy or a patient.
- Use prior authorization services, such as covermymeds.com, PARx Solutions or others.
Manufacturers also offer call-in numbers to help initiate a PA before the Rx even gets to the pharmacy. Your pharmaceutical reps can get you set up on these services, which saves a great deal of staff time and frustration.
- Consider bypassing insurance altogether.
Have you ever actually checked the cash price for the medications you take or prescribe? Often, timolol, maxitrol, polytrim and latanoprost are actually cheaper at big-box or department stores without insurance than they are when submitted through the patient’s insurance. For example, I personally take a generic version of synthroid, and it costs me $16 cash or $30 through my insurance. This is valuable information to share with patients, and it’s easy to find with just a few phone calls or by using apps like GoodRx Pro.
- Consider nonpharmaceutical approaches.
Meibum expression devices, blepharitis deep-cleaning devices, nutraceuticals and more are all great sources of alternatives that are not driven by prior authorization requirements. By the way, they also create revenue streams for your office.
- Try specialty pharmacies.
Specialty pharmacies are mail-order pharmacies that assist with coupon and rebate processing. They know the ins and outs of getting the best deal. I recently had a patient get a name-brand medication for $15 through Medly Pharmacy in Brooklyn; the cost at a major national drug store was more than $200. Obtaining PAs is among today’s business realities, so it’s important to establish processes within your practice to help your staff execute this process efficiently — for the benefit of the practice and the patient. Do you have a tip for easing the PA strain? Email me at [email protected].
Dr. Friedman is a partner in a private practice in Moorestown, New Jersey. She also serves on the HEA National Advisory Board.
Have a Question?
Dr. Kimberly Friedman would love to hear from you with questions on this topic or other ways to bring simple strategies for success into your practice. Email [email protected].