Electronic Prior Authorization Reform: What’s Next?

The legislation will streamline the prior authorization process for the more than 28 million Medicare Advantage members. Medicare Advantage (MA) plans, sometimes called “Part C” or “MA Plans,” are Medicare-approved plans from private companies offering an alternative to original Medicare for health and medication coverage.

4 Tips for Prior Authorization Success

Prior authorizations (prior auths or PAs) are a cost management tool utilized by insurance companies. PAs increase administrative costs for HCPs and create a healthcare obstacle for patients. HCPs depend on prior authorization approvals and insurance payments to remain in business. Healthcare providers (HCPs) must master a productive prior authorization workflow to improve productivity and revenue.

An Essential Guide to Step Therapy

Health insurance companies increasingly employ cost management strategies as more expensive, specialized drugs enter the market. The use of step therapy is one of these cost-control strategies. The goal of step therapy is for patients to try low-cost medications before moving on to more costly ones.

Will Prescriber “Gold Cards” Solve the Prior Authorization Problem?

Imagine a world with fewer prior authorizations. A new Texas law aims to make this dream a reality. House Bill 3459(HB 3459), or the “Gold Card Act,” grants prescribers a “continuous prior authorization exemption” if they have a 90% approval rating on previous authorization requests.

The Players of Prior Authorization

The prior authorization (prior auth, or PA) process itself can be complicated and requires both communication and a cohesive healthcare team. The healthcare team involved in the PA process consists of a provider or physician, the pharmacy, the payer, and the patient. Each player on this team plays a part in successful and positive patient outcomes.

Prior Authorizations are becoming a bigger burden- Now what?

For physicians like Terrence Regan, MD, a Urologist in Florida, prior authorizations are limiting access to important treatments for patients and are draining physician offices of resources and time.  According to the American Medical Association, 92% of care delays can be traced back to prior authorization requirements and 1 in 4 patients in 2021 will […]