Prior Authorization

This topic has 4 replies, 5 voices, and was last updated 1 year, 10 months ago by Avatar Donnalussier.

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    Discuss questions, give advice and share instances where prior authorization is hindering patient care.


    Based on discussions with commercial payors across the country, we should have seen a widespread evolution in Prior Authorization processes to improve efficiency, access to care, etc.

    We are interested in hearing the infusion provider perspective.
    (1) Have you seen any improvement in PA processes with your regional payors?
    (2) Are inefficient, nebulous, and overly burdensome Prior Authorization processes still impacting your patients’ access to care?
    (3) In your experience, is this mostly an issue restricting treatment-naive patients’ access to care or disrupting stable patients’ ability to remain on their treatment protocol?

    Lead Goon, Team NICA


    Prior authorizations are very time consuming. Any tips to speed up the process?


    We use! They take you straight to the plan and generate plan-based questions for each patient. Sometimes you even get an instant answer! Such a great resource for offices or home infusion!


    We had a difficult time using CoverMyMeds for IV Biologics. Most often the wrong form was provided therefore we fill out and send the correct forms to the Insurance company. If you learn to know what their needs are prior to sending, such as the right diagnoses, the right dose and med that matches the diagnosis, etc., we find that we can obtain a PA much faster. Another factor that helps with the PA process is constant communication with certain people in the insurance company. Learning who they are and which people seem to work the fastest for you results in a faster turn around time in obtaining a PA.

    We found using CoverMyMeds for SubQ medications works very well.

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