Issue: November 2016
November 14, 2016
4 min read

ODs get assistance with prior authorizations for prescriptions

PARx helps remove the clerical burden associated with ensuring patients get the drugs they are prescribed.

Issue: November 2016
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Optometrists say they are providing better patient care by using a prior authorization service that facilitates patients receiving insurance coverage of necessary medications.

PARx Solutions’ free support system helps prescribers and their staff process prior authorizations (PAs) without having to call insurance companies and search for forms.

“For a practitioner, prior authorization is a frustrating and burdensome process,” Dan Rubin, PARx Solutions president and CEO said in an interview with Primary Care Optometry News. “We are trying to make sure patients can get the medication best suited to treat their condition. We want to remove hurdles and give doctors power and confidence to write the prescription and have a strong likelihood that patients can get the medicine.”

Dan Rubin

Harvey Richman, OD, FAAO, FCOVD, a PARx user and private practitioner from Manasquan, N.J., told PCON that this service helps him make better clinical decisions.

“You can request prior authorization in under 3 minutes, which gets medications to patients sooner,” he said.

How it works

Rubin explained that a practice must first register with PARx before using its services, which involves signing a HIPAA Business Associate Agreement and providing the doctor’s National Provider Identifier number. The process takes about 5 minutes, he said.

When a doctor prescribes a drug that requires a PA, or if the practice is contacted by the pharmacy for a PA, a staff member logs onto the PARx web-based HIPAA-compliant portal and submits the request in a 3- to 4-minute process, Rubin said. The request goes to the PARx call center, where it is reviewed by their staff of nurses, pharmacy techs and medical assistants, who communicate with the plan and handle any follow-up, such as requests for chart notes.

PARx provides a universal form to its members and submits it on the practices’ behalf.

“We have a team of people at our call centers that review every form for completeness, submitting it to the insurance plan on behalf of prescribers ... following up with the plan if we don’t hear back in a timely manner,” Rubin explained. “If insurance asks for another form, we essentially take the burden from optometrists so they never have to interact with the plan for PA, and we manage it for them.

“PARx takes a complex process and simplifies it so practitioners never have to hunt for the right form,” he continued. “Just login to the site and fill in the information, including the reason they wrote the prescription for a particular product.”

The system maximizes the likelihood of positive outcomes and it is taken care of in the least amount of time, he said.

“PARx gives optometrists the confidence that there’s a much higher likelihood that the script will get dispensed to a patient and it will happen in a way that minimizes the time the office needs to spend on clerical work,” Rubin added.

Hurdles with old system

Richman said prior to using the PARx service, the process for obtaining a PA was inconvenient and time-consuming.

Harvey Richman

“We would call the insurance company, sit on hold for 20 to 30 minutes and communicate with two or three people before speaking with a pharmacist, then go down the list of all the documentation you filled out previously,” he said.

Alternatively, the office sent a fax request to the insurance company and waited 3 days for a response, a particular disadvantage when an immediate treatment was needed for a patient, he said.

Some doctors would change their prescription to a generic or over-the-counter agent, Richman said, rather than filling out paperwork or making phone calls to obtain authorization.

Now he said he recommends the service “daily to other ODs who complain about PA issues.”


Differentiating your practice

Charles Gold, OD, who practices in the Washington Heights area of Manhattan, New York, sees the PARx system as a way to differentiate himself from other practices.

“Patients know that we make every effort to get them the right drops compared to other offices,” he told PCON.

Gold said the PA service allows him to “do a better job for the patient” by providing more options.

“I can prescribe artificial tears, but I can also prescribe Restasis [cyclosporine ophthalmic emulsion, Allergan], which is a much better medication for dry eye,” he said.

Charles Gold

Gold noted that his Allergan drug representatives were the first to show the system to him and his office.

“The days of a drug rep walking in and handing you some samples and walking out is over,” he said. “They need to help your practice be better and help you prescribe a wider variety of medications.

“Prescription medications are all about access,” he continued. “It can be the greatest drug in the world. But we need to know how to prescribe it so the majority of the cost is paid by the insurance companies.”

Rubin said more than 13,000 eye care professions are registered for PARx Solutions’ services.

“Almost all of the branded eye care medications require some level of PA,” he said, “and it can vary by plan.”

He believes this service helps optometrists show patients they care about their health in making the effort to obtain the PA.

“Optometrists have happier staffs, and it takes the PA submission burden off of them,” he continued. “Now, they fill out a form that takes between 2 and 5 minutes and they are done. And all of this is free to the practice. I think having the freedom to practice their trade in the way they see fit is something practitioners value highly” – by Abigail Sutton

Disclosure: Gold and Richman reported no relevant financial disclosures. Rubin is president and CEO of PARx Solutions.