The fastest growing segment of the pharmaceutical industry is specialty pharmacy. By the year 2020, it is estimated that specialty drugs will represent 50% of drug cost reaching an astronomical cost of 400 billion or 9.1% of national health spending for only 2% to 4% of the US population.Future growth trajectories of specialty medications are expected to continue to grow at a very rapid rate.
Because of the rapid increase and demands in the prior authorization field in healthcare, more and more specialty pharmacies are providing the service of submitting prior authorizations on behalf of the providers and patients. It is imperative that the highest level of excellence in training, knowledge and execution of the PA process is attained for their staff.
Based on a 27-question survey administered by the American Medical Association, medical practices spend an average of two business days a week per physician on Prior Authorizations. On Average, this translates to 29.1 PA requests per physician per week that take 14.6 hours to process. Approximately half of prior authorization request are for medical services and half for medications. This can cost over $85,000 per year to support a full-time physician. Over 30 percent of practices employ a full-time employee that has dedicated all their time on Prior authorizations.
By choosing to certify your staff, you are choosing to make a great investment. You are choosing to educate your staff with the most comprehensive training program in the world. Achieving the PACS demonstrates the highest standards of knowledge, and excellence in the prior authorization field for both medications and medical services.
Through educating your staff on this rapidly growing and changing field, you can choose to make a major impact on your practice.
There are many people who are involved in initiating the prior authorization requests for the patient that may be admitted in a hospital or has outpatient services. Whether your staff includes, nurses, pharmacists, pharmacy techs, nurse practitioners, physician assistants, case managers, clerical staff, medical assistants, administrators or dedicated prior authorization specialists, the PACS can be beneficial and an investment. Often, the medical services and medications that require a prior authorization can be very expensive and difficult to achieve. If a prior authorization is denied, and the service has already been given, a Hospital may lose revenue. By properly training your staff with the highest level of standards and knowledge in the PACS program, you are investing in your staff, Hospital and patients.
It is no secret that the prior authorization field is a highly demanding, changing and growing field. Given the demands of turn around times for processing requests and seasonal variances in requests with enrollees, it becomes challenging for the payer to keep up at times. A health care plan’s quality and performance rating can be reduced when prior authorization requests are not processed in the given time frame. With the wide, seasonal and sometimes unpredictable market changes in prior authorization demands on a health plan, the payer (insurance company) is forced to hire temporary employees or contractors). Often times, the temporary employees have no knowledge or experience in prior authorizations, which can lead to hiring unqualified staff. Many times, this can result in a high turn over rate due to mistakes, slow processing times and inefficiencies. On average, a temporary or contracted employee will need 4 to 6 weeks of training before starting and may end up only working an additional 3 to 6 months. As a result, health plans lose a substantial amount of money on training, inefficiencies in the process and high turn-over rates of staff. There is also a greater risk of losing quality and performance ratings with unqualified staff.
By choosing to certify your staff, you are choosing to make a great investment. You are choosing to educate your staff with the most comprehensive training program in the world. Achieving the PACS demonstrates the highest standards of knowledge, and excellence in the prior authorization field.
Nothing can be more challenging to a sales representative who is given a medication in a territory with prior authorization restrictions. Although the physician may prefer his/her product, they many not prescribe it in order to avoid the burden of the PA. By addressing the challenges of the PA, a pharmaceutical company may yield tangible and substantial benefits.
Below is an excerpt “Tackling the Prior Authorization Challenge: A Critical Task for Pharma” published May 4, 2017
“For example, a sales representative took over a territory that had severe PA restrictions. While physicians preferred her product, they frequently switched to other formulary drugs to avoid the hassle of prior authorization. At the outset, this territory ranked 141 st in sales out of 150 territories nationally. After introducing practices to a PA service, practices in the territory developed a higher comfort level, knowing that the PA burden was being handled for them. As a result, this representative was able to increase sales while building strong relationships with practices, resulting in a climb to the 6 th ranked territory in the U.S providing their customers with the best PA solution is an effective approach to saving prescriptions and handling one of the most frequent and important barriers to physician prescribing and patient access.”
By providing the PACS training to your staff, you are choosing to make a great investment.