Brent discusses the challenges that patients, caregivers, and providers face when seeking access to medications requiring prior authorization. He explains how an electronic prior authorization solution can reduce delays and help patients start their therapies sooner—especially when patients and brands can play an active role in the process.
Click here to learn about CoverMyMeds’ electronic prior authorization solutions.
Read on for Brent’s insights.
How Prior Auth Solutions Can Empower Patients, Providers and Pharma Field Teams
By Brent Clifton, Vice President of Product Management at CoverMyMeds
Kathy shared with CoverMyMeds that she doesn’t take any medication without knowing why it works and how it works. She added that she’s also been known to call her pharmacist and doctor’s office for medical questions and her insurance company to proactively check her medication’s prior authorization status.
Unfortunately for many patients, being uninformed about a prescription can be a common experience, one that sometimes includes medication delays or access issues. The latest CoverMyMeds patient survey found that 66% were delayed at least 24 hours last year when picking up their medications—and 12% were delayed a week or more. (2023 CoverMyMeds Patient Survey) Of those who were delayed, 40% said it was due to insurance barriers like prior auth.
Patients in the CoverMyMeds survey also reported negative effects from medication delays, with 60% experiencing an increase of anxiety and/or stress, 40% worsening symptoms, and 18% a progression of their condition. (CoverMyMeds 2023 Patient Survey) For Kathy, missing one dose could lead to painful days and sleepless nights.
Leveraging electronic prior authorization (ePA) solutions can help reduce medication delays and access challenges for patients, their care teams and pharmaceutical brands. In addition to supporting providers through the prior auth completion process, the newest wave of ePA innovations can also help give patients and brands an active role in the prior auth process.
This article explores how the latest ePA innovations use connections to solve some of the most common medication access challenges.
HOW NEW ePA INNOVATIONS USE CONNECTIONS TO OVERCOME MEDICATION ACCESS BARRIERS
Solving medication access barriers is somewhat of an elusive goal for the healthcare industry, with numerous stakeholders often working separately to overcome these barriers. What is needed is a comprehensive approach. By bringing together stakeholders from across the healthcare spectrum, from health insurers to pharmaceutical companies, pharmacies and healthcare providers, a more complete strategy can be developed. For instance, a claim rejection requiring prior auth can present multiple barriers for various stakeholders that may lead to delays, switching or abandonment of a medication.
While prior auth-related barriers can be frustrating for providers, patients and pharmaceutical brands, the latest ePA innovations aim to better connect these parties. Sponsored ePA solutions have enabled providers to receive in-workflow, brand-specific optimized support throughout the prior auth process. Providers receive prior auth aid like automated follow-up and prior auth form and appeal support, among other benefits, to help more patients obtain their prescribed therapy instead of an alternative.
FIELD TEAM EMPOWERMENT
In addition to prior auth support for providers, pharmaceutical brand field teams can now view brand-specific prior auth insights, updated daily. These daily insights can assist brand field teams in office pre-call planning efforts and support more-informed conversations with providers about overcoming prior auth challenges.
Sales representative users of this new feature have so far given positive feedback, with 84% saying they somewhat or strongly agreed the tool assisted in pre-call planning. (CoverMyMeds sales representative survey, 2022) One surveyed representative said they liked the tool’s real-time information, as “other data sources have a multiple-week lag.”
Patients, too, could benefit from these shared insights. Sometimes requests can sit with the provider unsubmitted, until they are able to ask questions during a brand field team member visit. Kathy said she’s had prior auth requests delay her medications multiple times.
DIRECT PATIENT ENGAGEMENT
The newest ePA features can also now allow providers to share a prior auth outcome directly with their patient when a plan makes a determination. Patients like Kathy have never had this option before. In the past, for Kathy to play an active role in her prescribed therapy’s prior auth outcome, she had to call her insurance company to ask. That option was, “Less-than desirable…I mean, I could be on the phone on hold to get hold of somebody for two hours, right?” Kathy said.
Early results from this first step in a new patient-engagement channel have shown promise. Patients who were notified of an approved outcome were able to pick up their medication 1.5 days sooner on average, with 94% reporting they liked knowing about their prior auth’s outcome. (CoverMyMeds PA Notify data for approved PAs, 2022)
With greater visibility into the process come numerous benefits for providers, patients and pharmaceutical brands. Providers may feel more supported when discussing prior auth-related barriers with field teams. Patients can finally play an active role in the process and obtain therapy faster following a prior auth outcome notice. And pharmaceutical brands can feel confident about hurdling medication barriers like prior auth requests, knowing the full power of a connected network is working invisibly to solve their challenges.
New ePA innovations help make stakeholder connections that truly matter, by reducing prior auth-related obstacles and helping patients obtain their prescribed therapy faster. Kathy, for one, would welcome these improvements—especially if it keeps her more informed about her medications.
“I want more detail,” she said. “It's my background.”
LET’S CONNECT
Learn how CoverMyMeds can help make the right connections at the right time to overcome prior authorization barriers.
Sponsored guest posts are bylined articles that are screened by Drug Channels to ensure a topical relevance to our exclusive audience. These posts do not necessarily reflect our opinions and should not be considered endorsements. To find out how you can publish a guest post on Drug Channels, please contact Paula Fein (paula@DrugChannels.net).
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