What is the biggest bottleneck in healthcare delivery? Over the years, prior authorization has earned its reputation as a barrier to care. Despite being intended as a measure to ensure the most effective and cost-efficient treatment, the typical manual prior authorization process often has the opposite effect. A recent Mayo Clinic article, for example, looks at the impact of the prior authorization process on gastroenterologists and patients with inflammatory bowel disease (IBD). Research findings suggest that savings evaporate in the face of care delays that contribute to declining health and subsequently more utilization. One of the study’s co-authors, Dr. Francis… 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
