Drug Topics- August 11, 2008

28 DRUG TOPICS AUGUST 11, 2008 www.drugtopics.com Cover Story PHARMACISTS FIND THEMSELVES AT MERCY OF PRIOR AUTHORIZATION Survey shows, on average, 4.6 hours per week are spent channeling the approval process Martin Sipkoff S ecuring prior authorization (PA) is a time-consuming, frustrating, and costly process. It burdens the dispensing practice, irritates—even endangers—patients, and could be greatly simplified, if not eliminated, according to a consensus of pharmacists. Such sentiments were reflected in the hundreds of comments Drug Topics received in an online survey conducted the first two weeks in June. The 567 respondents almost all expressed frustration. They have suggestions on how to make the system better, but most said the problem is getting worse. “We should be allowed in nearly all cases to take care of the process ourselves rather than contact the physician to have them seek approval,” one pharmacist said. “It just makes sense.” “I’m not sure what we pharmacists can now do since we have no control over the situation,” another said. “We’re in the position of being at the (pharmacy benefit manager’s) mercy, trying to follow the rules they make up as they go.” Here is how one pharmacist, typical of many respondents, described the prior authorization process: “First, the call to the insurance company, then you have to call the doctor to have them call the insurance company, then you wait for the doctor to call the insurance company while the patient calls you every hour to check on the progress, then the doctor or the insurance company may or may not call you back to let you know of the progress or outcome. Meanwhile the patient is still calling you every hour.” All this adds up to a heavy workload. More than two thirds of respondents (69%) spend more than two hours a week dealing with prior authorizations. The average is 4.6 hours a week. How much time do you spend each week on obtaining prior authorizations? Less than 1 hour 4% 1-2 hours 27 3-4 hours 33 5-6 hours 16 7-8 hours 8 9-10 hours 3 More than 10 hours 9 Note: The mean of 4.6 hours was determined by counting “less than 1 hour” as 0.5 hours and “more than 10 hours” as 15 hours. Pharmacists offer solutions for prior authorization woes Pharmacists responding to a Drug Topics survey about prior authorizations gave a variety of responses to our inquiry as to what could be done to make the problem better. Many respondents said they believe pharmacists should be able to complete the prior authorization process on their own, without having to involve physicians, except in the case of some specialty drugs. Among the other responses: • Let doctors prescribe the drugs they believe best suit the needs of their patients. “Let the doctors be doctors,” a respondent said. “Insurance companies should not be in the business of controlling which medications doctors can and cannot prescribe,” another added. • Give patients “ownership of the process.” “I give the phone to the patient to hold while I’m waiting for approval,” one pharmacist said. “That way they know what we’re up against, and the next time they make sure the doctor got authorization.” • Create standardized forms for faxing to physicians. “To reduce the amount of time spent, I call the insurance company and get the prior authorization form faxed to me or to the office, with as much information already filled in,” a respondent said. “The doctor’s office is more likely to obtain a prior authorization in a timely fashion if I do this.” • All formulary information should be posted on a health plan’s or PBM’s Web site. • Improve communication between pharmacists and plans. “Insurance companies should make available via computer screen what alternatives are available for reimbursement,” a respondent said. • Improve communication between physicians and health plans. • Eliminate generics and low-cost maintenance drugs from the prior authorization process. “Requiring fewer prior authorizations is the answer,” one pharmacist said. “It is the single best solution.” Illustration: Jeff Suntala http://www.drugtopics.com

Table of Contents Feed for the Digital Edition of Drug Topics- August 11, 2008

Drug Topics- August 11, 2008 Contents Latebreakers Letters DEA Proposes Rule To Allow Electronic Prescriptions for Controlled Substances Merger, Medicare Reform Could Mean Broader E-Prescribing Adoption New Combination Pill Approved for Type 2 Diabetes New Eczema Guildlines Promote Use of Emollients, Then Topical Corticosteroids Agencies Flush Original Strategies in Favor of Promoting Drug Take-Back Programs JP at Large: You Laughing at Me? Pharmacists Find Themselves at Mercy of Prior Authorization State Law Requiring PBM Transparency See Some Gains, Some Losses Global Counterfeiting Still Growing, Says U.S. Commerce Official FDA Saftey Page: Prophylthiouracil Still Confused with Purinethol (mercaptopurine) New Products Bring Lice Treatment to a Head NACDS Marketplace Showcases New Product that Fill Unmet Needs Update on Respiratory Tract Infections Execs Share War Stories About Adopting Technology in their Stores New Products Advertisters Index Classified Viewpoint: Medicare Part D Revisions sorely needed

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.