Prior authorization for pharmaceuticals is a critical yet often complex and time-consuming process. Healthcare providers and pharmacists face off against a maze of requirements that differ from one pharmacy benefit manager (PBM) or payer to another. This can not only delay patient treatment but also piles on administrative overhead. As a result, choosing the right pharma prior authorization helps you optimize performance to reduce operational expenses while enhancing patient care. Here’s what you need to know. Pharma prior auth more prevalent than ever Specialty medications increasingly capture a larger slice of drug spending in the US. These complex drugs often… Read entire article here
In the ever-evolving realm of healthcare, oncology stands out as a field that requires prompt, precise, and above all, compassionate care. Every procedure, medication, or therapeutic session can be pivotal in a patient's battle against cancer. And herein lies the challenge: How do you ensure that potentially life-altering treatments earn prompt approval, reducing gaps in patients’ care journeys and in your revenue cycle simultaneously? Addressing process inefficiencies with prior authorization automation makes a huge difference. After all, prior authorization doesn’t just result in an approval or denial for patient care. It also confirms a payer’s commitment to reimburse you for… Read entire article here
October 4, 2023
Rebates, Discounts, and Formularies: How PBMs Shape Medication Access & the Benefits of Automating Prior Authorizations for Pharma and Medical Benefits
by Susan Lawson-Dawson | Healthcare Technology, Prior Authorization
As professionals deeply involved in patient care, understanding the complex dynamics of medication access represents a pivotal aspect of your role. Prescription medications are often the cornerstone of treating numerous health conditions, but how these medications are priced, accessed, and distributed can be enigmatic, to say the least. Some medications fall under medical benefits, such as injection or infusions of biologics for rheumatoid arthritis. Others, those self-administered by the patient, fall under pharmacy benefits. That’s where Pharmacy Benefit Managers (PBMs) enter the picture. This adds yet another layer to the already complicated world of prior authorizations, which often serves as… Read entire article here
Pharmacy Benefit Managers (PBMs) originated during the 1960s in response to the growing complexity of drug benefit programs within health insurance plans. Initially, PBMs’ primary role was to process prescriptions and handle the administrative burden for insurers. As the healthcare landscape evolved, so too did the responsibilities of PBMs, expanding to include drug formulary management, pharmacy network contracting, and drug utilization reviews. And of course, PBMs began using prior authorization to further manage costs. Is it any wonder that providers want a way to automate prior authorizations to relieve the administrative burden? That's where a prior authorization platform offering unified… Read entire article here
