How Much are Medication Prior Authorizations Costing Your Practice?

In its 90th Annual Physician Report, Medical Economics found that the average practice spends 15 hours per week on Prior Authorizations.

A 2018 AMA survey found that approximately half of requested Prior Authorizations (PAs) are for medications, meaning the average practice is spending over 7 hours a week on Medication PAs.  Depending upon the type of practice it could be much more.

Why do medication PAs take so much time?

  • They are Increasing – many publications report that medication PAs are increasing, particularly as new very expensive medications come on the market.
  • Insurance Coverage is Inconsistent – medication may not require a PA for one insurer but will for another.
  • Lack of Timely Information – providers are often unaware that a medication they have prescribed required a PA until well after they have prescribed it.
  • The PBM Maze – Pharmacy Benefit Managers often seem to have an intricate maze and set of hoops you have to jump through.  How many times have you been told, “we never received the fax”?

What’s the solution? Several things may help, including:

  1. Educating your patients – flyers and other handouts can help educate patients on the fact that prior authorizations may be required and if so, will slow down prescribing.  
  2. Making sure Formulary Checking (if available) is turned on and working in your EHR – this will help you catch formulary issues BEFORE you’ve prescribed the medication and allow you to possibly change the medication.
  3. Using your EHR’s Electronic Prior Authorization tools (if available) or considering an ancillary service such as Cover My Meds.
  4. Removing “frequent offenders” from your provider’s Favorite Meds list in the EHR and substituting or adding comparable medications that are less likely to require a PA.
  5. Getting coupons for your patients from your EHR or Drug Reps – the same medications that require a PA often have a coupon available.

Our shameless plug – Sevocity includes formulary checking and electronic Prior Authorization at no additional cost.  Contact Us to learn more or request a demo.