Comprehensive Prior Authorization Program
Industry Challenge
Appropriate prescription drug regimens are critical to preventing, treating, and managing many chronic and serious disease states. However, the consumer price of certain prescription drugs makes the cost burden to the payor even more extreme. Medicaid administrators are challenged to foster patient wellness through effective drug regimens, while at the same time controlling program costs.
Solution
Prior authorization (PA) programs help Medicaid administrators contain costs by requiring prescribers to obtain approval before prescribing a non-preferred medication. Used in conjunction with a preferred drug list (PDL), a clinical evidence-based PA program is a significant component of overall cost containment.
A comprehensive approach to prior authorization pairs an automated PA system with clinical-based review of all PAs that require further evaluation or fall outside of the criteria. HID’s RxPert® application and clinical PA evaluation services offer a technically exceptional automated PA system in conjunction with experienced evaluation by licensed pharmacy technicians, nurses, pharmacists, and physicians. This comprehensive solution speeds the PA approval process, yet also significantly improves patient safety and provider satisfaction, ensuring that providers are kept in the loop and patient needs do not “fall through the cracks.”
For more information on how HID’s Comprehensive PA Program can help your organization, contact us.