By: Louisa Wolowiecki

Have you ever thought about how different the healthcare landscape is now compared to years ago? 

A patient used to seek out medical care with their physician. The physician would diagnose and prescribe the needed prescription medication. The patient would fill their prescription at the pharmacy of their choice. 

Over time, as the expense of medications have climbed, insurance companies began incorporating many changes. One of these is mandating what is known as a “prior authorization” for the patient to have his or her certain prescription medication covered under their insurance plan.  

A prior authorization is defined as a requirement that your physician obtain approval from the patient’s prescription insurance plan to prescribe a specific medication for you. A PA is a technique for minimizing costs, whereby benefits are only paid if the prescription medication has been pre-approved by the insurance company.  

While no one disputes the importance of employing cost savings measures as necessary in keeping some of the overall prescription cost down, the practice of needing a PA for almost any brand name medication has become overwhelming for most prescribers’ offices 

This requirement of needing a PA is typically not even discovered until the patient is standing in the pharmacy waiting for his or her prescription only to find out this extra step is needed for the medication to be paid by insurance. 

Initiating a PA is an extra step for an already busy, limited staff, traditional retail pharmacy establishment. Additionally, the prescriber’s office is ultimately responsible for submitting the necessary information to the patient’s insurance company. Often there is much needed follow up with the insurance company as well as the prescriber’s office, again a lot of time for a retail pharmacist to spend. Unfortunately, the patient is the one who ends up going without his or her medication as they wait for the PA to be approved.  

At AlphaScrip and Nexus Patient Services, we shorten this gap by being focused and committed to working with the insurance providers and prescribers’ offices to make the best decision moving forward for the patient.  Our goal is to provide benefit verification, to manage and minimize the amount of time waiting for insurance approval.  This additionally translates to better medication adherence and disease management outcomes for our patients as well as better communication with their clinicians.  

You can find more information on how we can support your patients toward improved adherence and disease state management at www.nexuspatientservices