ARE PRIOR AUTHORIZATIONS GIVING YOU A HEADACHE AND COSTING YOU TIME AND MONEY?

 

WE CAN REDUCE YOUR PRIOR AUTHORIZATIONS FROM MANY HOURS TO ONLY 1 MINUTE, SAVING YOU $80.00 per PA, ON AVERAGE! AMA

 

Health plans, employers and government-sponsored health care programs are focusing their attention on optimizing patient outcomes with medications that have established evidence of efficacy and safety, while providing the highest value. Implementation of a well-designed, evidence-based prior authorization program optimizes patient outcomes by ensuring that patients receive the most appropriate medications while reducing waste, error and unnecessary prescription drug use and cost. PRIOR AUTHORIZATION SOFTWARE (PA) is an essential tool that QCP uses to ensure that drug benefits are administered as designed and that plan members receive the medication therapy that is safe, effective for their condition, and provides the greatest value.

QCP

Prior authorization requires the prescriber to receive pre-approval for prescribing a particular drug in order for that medication to qualify for coverage under the terms of the pharmacy benefit plan. Guidelines and administrative policies for prior authorization are developed by pharmacists and other qualified health professionals.  Each managed care organization develops guidelines and coverage criteria that are most appropriate for their specific patient population and makes its own decisions about how they are implemented and used. Well-designed prior authorization programs consider the workflow impact on health care system users and minimize inconvenience for patients and providers.

Prior authorization can be used for medications that have a high potential for misuse or inappropriate use. For some categories, health plans may limit the coverage of drugs to FDA approved uses and require a prior authorization for off-label indications. An example of an off label use could be a physician prescribing a powerful opiate that has only been approved by the FDA to treat breakthrough cancer pain, in a patient that has chronic back pain. In this case, there is insufficient clinical evidence supporting the use of the medication for non-cancer purposes and prescribing such a medication could pose a serious safety risk for the patient. Prior authorization would be used to limit coverage in this situation to those patients where safety and appropriate use has been documented.