Six Key Takeaways From the Prior Authorization Panel

• Theresa Gallagher, RN, BSN, Care Manager - Great Lakes PO Bobby Dabicci, PharmD - Lakeland
• Tiffini Jones, RN, BSN, CDCES - GMP Network
• Renea Clark, Practice Coordinator/Quality Support Specialist - LPO, LLC
• Heather Keifer, MS, RD, CDCES - Holland
• Connie McDonald, RN, CCP, Care Manager from - St. Mary’s PHO
• And special guest: Kate Dorsey, of the Michigan State Medical Society, who provided an overview of Senate Bill 247, a new state law in Michigan that reforms the prior authorization process by reducing wait times and streamlining how physician offices and payers interact, all with a goal of reducing endless paperwork and ultimately improving access to care for patients.

SIX KEY TAKEAWAYS

1. Build EMR note templates that prompt providers to include PA requirements as part of the patient’s chart. If you know you will need documentation of metformin trial or failure, prompt providers to include that status in a patient’s chart so the information is ready to go for a Prior Authorization.
2. Try ePrescribing software like Parachute (for CGM and other durable medical equipment) and Cover My Meds. These tools can streamline PA process and allow care teams to track where they are in the approval process.
3. Set expectations with patients with clear and coordinated communication. If you anticipate a lengthy PA process, let the patient know at the time of prescribing. An ePrescribing tool and communication protocol can insure that if and when a patient calls the office for an update, any member of the care team will be able to provide a timely update with clear expectations.
4. If possible, avoid PAsby pointing towards the approved and preferred drug in each medication class. Use tools like the MCT2D Coverage reference guide and empower medical assistants and other members of the care team to know and suggest equivalent drugs in the same class that are preferred (vs. not covered) for each insurance type. From the beginning, try to connect patients with the best drug with the best coverage for their plan.
5. Utilize Patient Assistance Programs (PAP). Prior authorizations will not solve the problem of expensive medications and the Medicare donut hole for coverage. Many patients could qualify for free SGLT2 i and GLP-1 RA medications provided by the drug’s manufacturer, just by completing an application for a Patient Assistance Program. This can help you avoid the PA process all together.
6. Advocate for policy reform like Michigan Senate Bill 247, to press for system-level improvements to prior authorization.

Member Recommended Prior Authorization Resources

Fingertip Formulary - A Web and iPad-based Formulary Lookup Tool

A tool that compiles drug formularies across commercial, Medicare, Medicaid, health exchange plans and allows users to construct and save searches for drug coverage information by drug and by plan.

Cover My Meds - Prior Authorization Support Web Platform

Cover My Meds is a web-based platform that automates certain processes within the prior authorization process, connecting clinical practices with some insurers to electronically expedite and track aspects of the prior authorization process online.

Coverage Search - A Mobile App from MMIT Networks

A free iPhone (iOS) and Android app to check medication coverage based on insurance type, created by MMIT Network.

Parachute Health - DME ePrescribing Tool

Recommended by MCT2D members who specialize in prior authorization, Parachute Health is an online platform to speed and simplify electronic prescribing of durable medical equipment.