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Prior Authorizations: Helping Patients Leap the Hurdles

Aug 24, 2017

A physician’s prescription does not ensure the patient will receive a medication—no matter how appropriate or effective. Payers increasingly require prior authorization (PA). Failure to procure one can mean claim denial, even if the drug was considered a covered expense.

The prior authorization process presents barriers to patients—as well as to pharmaceutical manufacturers’ bottom lines. According to PharmaExex.com, patients who need a PA receive the prescribed drug less than 30 percent of the time. Such patients might need additional provider visits or even inpatient hospital care. Almost 40 percent of patients needing a PA abandon therapy, reducing the number of potential medication users.

Manufacturers need an experienced hub partner to help patients get on therapy. WRB, an EnvoyHealth company, can coordinate the prior authorization process.

Benefits to Partnering With a Hub Services Provider

Expand your patient base. WRB’s trained, experienced reimbursement specialists can relieve the burden on providers and remove patient barriers. This results in quicker patient access to manufacturers’ medications.

Eliminate coding errors and denied claims. WRB’s reimbursement specialists deal daily with prior authorizations, benefit verifications, and denied or underpaid claims. WRB has the expertise to conduct in-depth investigations efficiently.

Boost patient adherence. Patients have 24/7 multichannel access to WRB specialists. Our professional staff builds relationships with patients, giving them manufacturer-approved information to help them understand their therapies. This helps increase adherence and gives manufacturers better and more complete data.

When manufacturers, patients, and providers use WRB’s hub services, success rates for PA initiation and appeals rise dramatically. In 2016, EnvoyHealth had almost a 75 percent success rate securing new PAs and a 95 percent success rate renewing existing PAs.1

Helping patients overcome barriers to access is a foundational service that broadens your patient pool and increases your data quality. WRB looks forward to helping you get patients the medications they need.

1 EnvoyHealth Internal Data, 2016.

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