Insurer or Pharmacy Benefits Manager

Payers are very aware of specialty drug trends and the prior authorization process. Other stakeholders may not be as aware, particularly patients, who are most impacted by the process.

There are many stakeholders involved in the prior authorization process, each of whom will rely on you to help them understand your unique process and criteria.

It is important that you provide a clear written communication to plan members with details of any additional information requirements or why their claim has been denied. When a plan member understands the reason for your decision, they are better equipped to discuss options and next steps with their physician or patient support program.

The technology exists today for patients and their physician to complete prior authorization claim forms online and submit them directly to payers. Electronic prior authorization (ePA) will deliver benefits to all stakeholders, including payers. Not only does ePA make the claims process more efficient, it can also reduce administration costs for insurers and other stakeholders in the process.