Utilizing near real-time prior authorization clinical approvals, like those provided by SamplifyRx’s RapidPA Score™, improves the entire specialty PA experience: RapidPA Score™ gives the patient an actionable decision before they leave the physician’s office-taking the process from 5 days to 5 minutes. In the case of a mid-range RapidPA Score™ the clinical pharmacist has immediate access to all supporting documentation in a centralized electronic portal. The prescriber can then make step therapy modifications before the patient leaves. If a patient’s score falls within a pre-defined range and their criteria have been met, the patient should be immediately approved.Ĭonversely, if the RapidPA Score™ falls below the pre-defined threshold, the PBM knows that the patient is not eligible immediately. RapidPA Score™ allows a PBM to set its approval criteria within the dynamic PA. As a result, the PBM can now make informed decisions automatically or manually. By utilizing a customizable, proprietary algorithm, a PBM can expedite the PA approval process by quantifying the decision support questions. SamplifyRx has created RapidPA Score™-the first scoring system for specialty prior authorizations. SamplifyRx estimates that the current system results in an astounding 4 quintillion potential workflow options. ( source) A specialty physician’s office typically has one to three 3 full-time employees who are dedicated to prior authorizations. Patient support programs remain in queue until the PA is approved (OIG and CMS compliance)Įliminate the PDF Library and Use the Dynamic PAĪt least $23 billion-equal to 10% of prescribers’ revenues-is used for interaction with health plans.Data readily available not in independent silos.HIPAA-compliant, seamless document sharing.Notification-driven communication versus faxes or encrypted emails.All data can be queried and shared regardless of ePA or HER.Utilizing a cloud-based system provides numerous advantages over direct integration: The specialty process also requires evidence-based document management, outcomes decisions, and coordination of patient support programs. While NCPDP has advanced and transformed prior authorizations, it still requires the prescriber, specialty pharmacy, and PBM to be fully integrated.ĮPA pharmacy benefit and claims management is not enough. The NCPDP formats for eRx and ePA provide tremendous value for interoperability. A recent ONC report examined allegations that some health care providers and health IT developers are engaging in “information blocking,” deliberately interfering with the exchange or use of electronic health information. If you like helpful tips like this, follow us on Twitter to stay up to date on our most recent blog posts as well as retweets from other digital commerce industry leaders.Today, interoperability can be limited due to implementation costs, time, and contractual constraints. Here is an example from Tobias Ahlin’s blog of Loremify in action. It lets you wrap the dummy text in HTML or markdown, specify the amount of text, and copy it to your clipboard-all in one click.” “Loremify is a free Mac app to quickly copy Lorem Ipsum to your clipboard. Tobias Bjerrome Ahlin is the interface designer who developed this awesome tool, and he describes it as follows: This widget allows for quick and easy grabs of the perfect amount of text for your needs. If you don’t like doing a search online for “Lorem Ipsum”, finding the right amount of text needed, and then copy/paste into your design every time you need to use Lorem Ipsum, then you should download Loremify. Wikipedia explains Lorem Ipsum as “ placeholder text (filler text) commonly used to demonstrate the graphic elements of a document or visual presentation, such as font, typography, and layout.” Basically, this gives designers one less thing to worry about, so as not to get in the way of the creative process.
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