Reducing the Negative Side of Prior Authorization

Guest post by Robert S. Oscar, R.Ph. CEO and president, RxEOB.

Robert Oscar
Robert Oscar

Prior authorization exists to reduce drug costs, to manage appropriate brand medication prescribing, and to curb medication abuse. Despite its good intentions, this extra step to determine whether or not a drug is appropriate for a patient’s symptoms has gained a reputation of inconvenience for both physicians and consumers.

In a 2013 study by SUNY Upstate Medical University, it was revealed that U.S. primary care physicians and their office staff have experienced significant increases in time consumption as a result of prior authorization and its associated requirements. For consumers, hours can be wasted waiting to find out whether or not they are allowed a particular prescription under the conditions of their health plan.

Reducing this negative aspect of prior authorization is paramount for the betterment of overall health costs and medication adherence. By streamlining the time spent between medical record lookup and prescription delivery, healthcare organizations and consumers can begin to experience more efficient prior authorization. If efforts made toward better big data advancements, mobile health (mHealth) and health IT are prioritized, doctors can confirm drug eligibility faster to help their patients recover faster.

Below are five reductions that can come from implementing electronic prior authorization (e-PA):

Reduced Labor Costs: When a doctor pulls up a patient’s medical records he must sift through numerous data points to determine which drugs are approved and which drugs are going to require prior authorization. The hours spent processing this data is costly for healthcare staffing, but lost time can be reduced by moving the process online and implementing electronic methods. This can allow physician offices and PBMs the ability to review, submit and determine authorization almost immediately.

Reduced Consumer Delays: A consumer will typically experience the unattractive side of prior authorization at the pharmacy. If a doctor issues a prescription without knowing the patient’s medication history or pushes a popular name brand drug without suggesting a generic, the consumer will likely get sidelined with prior authorization processing at the point of sale. Having an e-PA process that can review and determine which drugs a patient is already approved for before they head to the pharmacy can reduce customer wait times and greatly increase consumer satisfaction.

Continue Reading

Taking Health into Our Own Hands: Mobile Technology, Apps and the Coming Healthcare Revolution


Guest post by Robert Oscar, R.Ph., founder of RxEOB.

Mobile technology has changed the way we live in dramatic fashion. Now it’s changing the way we access healthcare and medical information. In fact, the popularity of health-related smartphone apps as on-the-go tools has skyrocketed. Our smartphones and other mobile devices have made health and wellness choices simple and convenient.

More people than ever before are finding physicians, managing weight, controlling allergies, looking up symptoms, making doctor appointments and even checking into the hospital through their smartphones. For the house-bound and people living in rural areas, this technology can actually save lives by greatly improving connectivity and access to care, and streamlining self-management of such chronic diseases as diabetes, asthma and high blood pressure.

Health apps can also make medical-financial tasks easier, such as integrating financial data from high-deductible health plans or comparing prices between pharmacies. Furthermore, health apps can help streamline the flow of information between health plans, physicians and patients — making communication easier, quicker and more informative.

At work, employees can take greater control of their own health and work more closely with in-network healthcare providers. This is especially true for those who are looking to save money and reduce their out-of-pocket healthcare expenses.

Today, health-related apps are used mostly for accessing information, with some mobile devices making one-on-one interaction possible. As more hospitals and doctors begin to use apps, they will be able to reach more people with greater efficiency. Along these same lines, apps designed for physicians will become better at connecting to patients’ clinical records so that information can be easily shared — where and when it is need.

The impact of the mobile app revolution is expected to grow. In fact, a recent study found that nearly 17 million consumers were accessing health information on mobile devices in 2011, according to American Medical News, representing a 125 percent increase from 2010. These statistics have experts predicting that healthcare and medical app downloads will reach 44 million this year, and 142 million by 2016.

Consider the example of a large shipping company that participated in a pilot project involving a new mobile health app. Early reports showed that 42 percent of employees who used the app saved money on their prescription drug costs, according to Employee Benefit News. These employees had easy access to prescription drug plan information via their desktop and smartphones. End result, a whopping 71 percent of the participants said they’d recommend the service, and the company savings ranged between $174 and $366 per user per year.

Ultimately, health-related apps and the wealth of information they provide help patients become more engaged in their health so that they can make better choices, cuts costs and, eventually, help ease the strain on the US healthcare system.

Robert Oscar, R.Ph., has more than 25 years of experience in healthcare. Throughout much of his career, Oscar has developed and implemented successful programs to effectively manage pharmacy benefit risk including pioneering work in the Medicare HMO market. Before founding RxEOB more than a decade ago, Oscar worked in the medical information systems industry, designing, developing and implementing several different claims analysis tools. Licensed in Virginia and certified in pharmacy-based immunization, Oscar is a graduate of Ohio Northern University.