As we step into December, recognized globally as the Gift of Sight Month, we’re shining a spotlight on how advancements in healthcare administration, particularly in automated prior authorizations, brighten the prospects for patients at risk of sight-related health issues and the providers who care for them. 

The vital link between eye health & prior authorizations

Eye conditions, ranging from diabetic retinopathy to glaucoma, can escalate rapidly, turning from minor issues into sight-threatening emergencies. In fact, untreated diabetic retinopathy increases the risk of blindness 25X compared to non-diabetics. Timely access to treatment is not just beneficial for these patients; it’s critical. Unfortunately, prior authorizations often stand in the way.   

Dr. Ruth Williams, Past President of the American Academy of Ophthalmology (AAO) and  EyeNet’s  Chief Medical Editor shared her own frustrations with a burdensome prior authorization process. Writing in the March 2022 EyeNet issue, Dr. Williams notes, “As if we didn’t have enough stress, employee burnout, and unique challenges during the pandemic, last July, Aetna implemented prior authorization requirements for cataract surgery.” She goes on to offer examples of the burden prior authorization poses to patients, including one where a 71-year-old was denied authorization for cataract surgery, despite having 20/60 vision in both eyes. 

Dr. Williams attributed the denial to a poorly-framed questionnaire, but that’s just the tip of the iceberg. Prior authorization remains a leading contributor to delays and denials that disrupt needed care. Fortunately, a concerted, year-long effort by The American Society of Cataract and Refractive Surgery (ASRCS) convinced the payer in question to roll back its prior authorization requirement. Unfortunately, the lack of consistent standards from payer to payer or even policy to policy—especially among Medicare Advantage (MA) offerings—means providers and patients still don’t experience a clear care path for managing eye health. 

Despite increased adoption of health information technologies, pursuit of prior authorizations remains a time-consuming and manual process, usually involving numerous phone calls and faxes. For conditions threatening eye health, where time is of the essence, delays in prior authorizations contribute to  worsening of the condition, potentially resulting in irreversible sight loss.

Automated prior authorizations offer a clear path forward

While many surgical treatments for eye disease require prior authorization, they aren’t the only issue. The rise of specialty medications, and with them, higher costs, increases use of prior authorization. For example, Oxervate, an FDA-approved ophthalmic medication to treat the degenerative corneal disease known as neurotrophic keratitis, costs nearly $97,000 for an 8-week treatment regime. Understandably, payers want to ensure that less costly options have been considered. But as Emilie Seitz, OD writes in Eyes On Eyecare, “No one covered this frontier in school or in residency. The class Ocular Pharmacologics: Getting Insurance Companies to Remember You Have a Degree never showed up on my transcript. Nevertheless, as a doc who manages A LOT of dry eye and glaucoma, it’s a problem I face weekly.”  

Automating prior authorizations reduces the administrative burden, especially when using a unified platform that can handle medications that fall under medical OR pharmacy benefits. Not only does this type of prior authorization software take away repetitive data entry, but it checks for accuracy and missing information, reducing preventable denials that might otherwise add to your workload. It also can expedite approval processes on the payer side by offering data-driven insights into past approvals, allowing for customizable auto-adjudication. 

Faster care access equates to better outcomes 

For patients, particularly those facing serious eye conditions, automated prior authorizations mean quicker access to necessary medications and treatments. In eye health, where early intervention is often key to preventing serious complications, reducing administrative delays is not just a matter of convenience but of preserving sight.

Healthcare providers, too, find themselves freed from administrative tasks. Clinicians can spend more time with patients. Staff can move on to more rewarding, higher value work. By relieving the overwork caused by prior authorizations, providers can stay focused on patient care rather than paperwork. This shift not only enhances the quality of care but also improves patient-provider interactions—a crucial element in treatment adherence and outcomes.

As we advocate for the Gift of Sight this December, we also recognize the role of technologies like automated prior authorizations in safeguarding eye health. By streamlining healthcare administration, we not only enhance operational efficiency but more importantly, protect and preserve one of our most precious senses—sight. Let’s embrace these advancements and look towards a future where administrative delays no longer cloud our vision of optimal healthcare. 

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