Prior authorization requests are a permission slip from health plans for their patient to begin taking a medication, ensuring the right therapy for the condition and cost-effectiveness. Prior authorization requests are not just for specialty drugs. It also applies to brand-name drugs and their generic counterparts.

In this edition of Pharmacist to Pharmacist, Michael Bukach discusses how electronic prior authorizations, or ePAs, can conquer the operational, clinical and financial challenges that manual PAs can pose for your chain pharmacy. Bukach, Senior Vice President of Pharmacy for McKesson’s CoverMyMeds unit, explains how your patients and your business can benefit from making the switch.

What are you responsible for in your role at McKesson?

Bukach: I work with the team at CoverMyMeds that helps our chain pharmacy customers adopt electronic prior authorization (ePA) at all their pharmacy locations. With ePA installed at most of our customers’ sites, our focus now is working with end users—the pharmacists—to make sure that we’re delivering what we said we’d deliver and to help them use our technology to meet their goals.

Navigating Prior Authorizations at Your Chain PharmacyWhat are some common operational challenges that you hear from your chain pharmacy customers?

Bukach: When it comes to prior authorization (PA), it’s all about workflow. Filling out a PA request manually is labor intensive. Before switching to ePA, some of our pharmacy customers had folders of notes on different drugs, health plan requirements, PA forms and contact info for doctors. When a patient came in with a prescription, they would go through their folders to find out if the patient’s health plan needed PA before filling it. And then the PA approval process itself could take days or weeks.

How does ePA streamline that process for chain pharmacies?

Bukach: All that information from their boxes and their folders is now digital and integrated into their pharmacy management system (PMS). Now, when a prescription comes into their PMS electronically, the system determines whether a PA is required and then transmits that PA request immediately to the physician. The pharmacy can do it all online without paper or faxes or phone calls. What used to take days or weeks now takes just minutes or a few hours. It changes the whole workflow at your pharmacy and can dramatically improve your operational efficiency.

How can chain pharmacies convert that operational efficiency into better care for patients?

Bukach: It really helps in two ways. The first and most obvious way involves the drugs themselves. You can get patients on the drugs that their doctors wanted them to be on. And you can do that without delays from PA requirements. Your patients can have better health outcomes by starting their drug treatments right away, rather than waiting for days or weeks or maybe not [starting them] at all. The second and less obvious way ePA helps is time. Think of all the time that your pharmacists spent on PA in the past. Now they can spend that time with patients. They can talk to patients about their conditions, proper medication use, drug adherence and other behaviors that can affect their health outcomes.

How does streamlining prior authorization help chain pharmacies from a business standpoint?

Bukach: The big concern that we hear from our chain pharmacies is prescription abandonment. That’s when a patient doesn’t get their prescription filled because the PA request wasn’t started, or PA determination took too long. Not only is your pharmacy losing that fill, you’re losing all the refills, too. That’s lost revenue. Making things worse, many of the drugs that require PA are for chronic diseases. So, when patients don’t come in for their drugs, they’re not there buying other chronic care products that you sell. It’s also going to cost you more, because you have to reverse the claim that you submitted to the insurer. And you have to put those unused drugs back in stock. All of that takes a lot of time, effort and energy in addition to it interrupting your workflow. The benefits of ePA are more revenue and lower costs versus less revenue and higher costs.

What market trends do you see affecting the importance of prior authorization to chain pharmacies?

Bukach: I see two. The first is specialty. I’m talking about the boom in the number of high-cost specialty drugs that require PA requests. Pharmacies will need to be even more efficient at processing PA requests because of patients’ health needs and because of the business that it represents to your chain. The second is transparency. Pharmacists can now tell patients that their drugs may cost less out-of-pocket if they pay cash instead of using their prescription drug benefits. Health plans drive PA requirements, so if patients pay cash outside of their health plans, there are no PAs. Knowing what to do and when to do it will become a skill you need to acquire.

What other trends should chain pharmacies stay on top of and why?

Bukach: Pharmacogenomics is going to be a big thing in our profession. That’s knowing how a patient’s genetic makeup will affect how they respond to a drug that a doctor has prescribed to them. By testing a patient’s DNA, you’ll know as a pharmacist whether the drug will or won’t work. And you’ll know whether or not it will work in concert with other drugs. How powerful is that? Think of the clinical benefits for your patients. You won’t be putting patients on drugs that have no chance of working. That will drive more value to your patients and to the healthcare system as a whole from a cost standpoint, too. And it’s not just saving the cost of a drug that doesn’t work. It’s the cost of sending someone to the hospital with a stroke because the blood pressure drug you [dispensed to them] didn’t work.

What you’re describing is the further transition of pharmacists into providers. Do you agree with that?

Bukach: I’ve been around so long that I remember when states first gave pharmacists the authority to prescribe common drugs that pharmacies now sell over-the-counter. Somewhere along the line, we lost that momentum, and states relegated us to filling prescriptions and putting pills in bottles. It’s time that we get that momentum back and practice at the top of our licenses. Pharmacy schools train us to be providers, and we can do things that patients need, like point-of-care testing and prescribing drugs based on those test results.

What do you enjoy most about being a pharmacist?

Bukach: For me, it’s about connecting with people. When I worked at a small chain pharmacy in Ohio, I always took it upon myself to connect with the difficult patients everyone else would avoid. I kept talking to them until they would finally open up and have a real conversation with me. Then I’d find out what was really going on in their lives that affected how they behaved. It was only then, after making that personal connection, that I, as a pharmacist, could help them with their health needs.

Editor’s note: If you have a question for one of our pharmacists, please leave a comment and let us know. We’ll be sure to cover it in a future edition of Pharmacist to Pharmacist.

Related: Learn more about McKesson’s prior authorization solution for pharmacies

McKesson

About the author

McKesson editorial staff is committed to sharing innovative approaches and insights so our customers can get the most out of their business solutions and identify areas for operational improvement and revenue growth.

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