Prior authorizations are not very popular among providers due to their heavy administrative burden and the barriers they seem to erect before good patient care. Nevertheless, prior authorizations are an important tool in controlling costs for payers. Although electronic prior authorizations are gaining steam, many providers are still reluctant to use them. Almost 50% of submissions are still done over fax or phone.
“Prior authorization has not changed much in the last five years, but we have seen a shift in the method in which prior authorization requests are submitted,” says Caitlin Graham, vice president of Core Network, a division of CoverMyMeds, a healthcare technology company in Columbus, Ohio, owned by McKesson Corporation. “Traditionally, the prior authorization process has been cumbersome, with providers and health plans exchanging phone calls and faxes,” says Graham. “It is a time-intensive process (Graham puts it rather mildly) that places a burden on pharmacists, providers, health plans and, most critically, the patient who is waiting.”
The COVID-19 pandemic resulted in prior authorizations for many diagnostic tests and services related to the virus to be suspended. David Lassen, Pharm.D., chief clinical officer at Prime Therapeutics, a PBM headquartered in the suburban Twin Cities and owned by Blue Cross Blue Shield plans remarked, “COVID-19 will likely have a transformative impact on the future as telehealth, and digital automation and tools continue to evolve to meet the rapid demand for greater efficiency and effectiveness in the process.”
Electronic prior authorization (ePA) may be a middle ground for both payers and providers. As providers increasingly adopt ePA software, the inconvenience and wait time for prescriptions start to decline—if providers are receptive to the new ePA technology. Read the full story here.
(Source: Donna Marbury, Managed Healthcare Executive, August 27, 2020)