SOLUTIONS
PRIOR AUTHS Tips from independent pharmacists on resolving prior authorizations
B
urdensome administrative tasks are part and parcel of running
a small business. But most tasks can be smoothly incorporated
into the pharmacy's schedule without disrupting patient care or
pharmacy operations. You can carve out time for say accounting and billing, but prior authorizations can arrive at any moment and interrupt filling, counseling, or any other number of important activities, which makes them particularly exasperating. "Just the mention of the words "prior authorization" seems to put my staff into a stress coma!" exclaimed Tom Bragdon, owner of Pioneer Drug in Newman, California. Bragdon estimates that 10 percent of total new prescriptions require a prior authorization, and there's usually a jump at the new year and when patients switch insurance. And the process varies considerably among prescribers and insurance, with resolution coming in as little as one hour to as much as several weeks, he said. Prior authorizations are not a new burden for pharmacies, but according to pharmacists, the number of these administrative annoyances keeps growing. As more specialty medications enter the market, as formularies narrow, and as insurance companies vertically integrate, prior authorizations only become more common. For many pharmacies, prior authorizations pop up as much as five times a day. And that takes a toll on pharmacy staff and operations. "Prior authorizations are extremely burdensome on the pharmacy staff taking time to process, receive an electronic reject, write up a request, send to the physician's office, and follow up," Bragdon said. At Palace Drug in Mammoth Spring, Arkansas, the time spent on prior authorizations accumulates to up to an hour each day. "It causes problems in workflow and leads to unhappy customers," said M.J. Clark, pharmacy director of Palace Drug. Besides the disruption to workflow, prior authorizations can cause real problems for patients if they have to go several days or weeks without their medication. And at some point during the process, the pharmacy might lose a patient due to frustration. Between insurance, the patient, and the prescriber, controlling prior authorizations is only partly in the hands of the pharmacy, but there are a few ways you can help streamline the process and keep patients happy. COMMUNICATING WITH PATIENTS Imagine coming into your preferred community pharmacy to pick up your medication only to be told it not only isn't ready, but it may take a couple of days before the pharmacy is allowed to dispense it. And actually, insurance may require you to get a different
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medication altogether. You hear the terms "authorization" and "rejection," even though your doctor has already authorized it. For patients, who expected to grab their medication and be on their way, this conversation understandably causes frustration, and confusion. "Patients don't understand a lot of times when you tell them they need an authorization," Clark said. "They're like, "Well my doctor prescribed it, why isn't that authorization enough?" They don't understand formularies or contracts or anything like that. The frustration and confusion can result in a patient abandoning a therapy altogether, and potentially abandoning the pharmacy. That's why it is so important for the pharmacy to have a consistent, effective way of explaining prior authorizations to patients to help them understand and to put them at ease. "Communication at the end of the day is key," Clark said. "That way everyone at least knows the goal is trying to be accomplished." Hannah Bors, pharmacy manager of Oswald's Pharmacy in Naperville, Illinois, makes sure the patient is the first person she takes care of in the case of an authorization, spending as much time as needed to explain the situation to them. Bors used to work for a national chain pharmacy, and pharmacists there did not have
