According to a survey conducted by the AMA in December 2016, only 40% of primary care and 60% of specialty physicians routinely complete prior authorization orders in their practice. This is mainly due to PAs relying on outdated methods such as fax order forms and multiple rounds of phone tag. Legacy EHR systems deployed across much of the health care landscape prevent physicians from getting the information they need, digitally, across the spectrum of care, leaving many to revert back to paper and fax. Many providers aren’t aware if and when a PA is approved or denied until they make a phone call to the pharmacy after being prompted by desperate patients and caregivers. Instead of getting tangled up in this quagmire, they are forced to abandon the process and switch treatment strategies. This is not how it should work.

Luckily, with today’s innovative minds in health care and next-generation technology, it is easier than ever before to develop solutions that streamline this cumbersome process, relieving the administrative burden for clinicians and their staff, and in turn, leading to positive outcomes for patients.


So what can be done? A look into the future.
Adopting next-generation tools and technology digitizing the current process, and building a network of health care stakeholders, will help reduce the administrative burden on physicians and get patients their treatments faster. Instead of dealing with fax machines, physicians can then order a specialty prescription, thereby eliminating the paperwork needed to get the medication approved, obtain signatures, enroll patients in critical services, and follow its progress all the way to the patient’s hands – all through the screen of their smart phone and computer.

Today’s systems can also do most of the heavy lifting for the health care management team, including notifying patients or clinicians when things stall. By having an accurate and easily accessible record of regimen and prior authorization history, physician and clinical staff’s administrative time can be significantly reduced and current manual workflows can be automated.

With this increased level of transparency, physicians now have a better lens into the available treatments under each patient's insurance plan, even the preferred medications. They can better inform their patients on the status of the prescription and even enroll patients in programs that ship starter kits, so that patient can get on drug as soon as possible. To take it one step further, new technologies can also help patients to find the financial help they may need to pay for these medications. This will improve patient satisfaction and speed up time-to-treatment dramatically.

Many companies today are dedicated to solving the larger issue within health care of filling the gaps and creating a more transparent, simple process. For specialty pharmacy, this resolution is not only crucial for lessening administrative burden and reducing physician/clinician burnout, but significantly improving patients' lives. While we have a way to go, the progress we’ve made as an industry to date is promising. and over the next few years, hopefully sooner, we will start to see a significant improvement in the prescribing process, enabling easy and expedited access to lifesaving treatment.


About the author: James Cornicelli, is VP of corporate strategy at ZappRx
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