prior authorizations

Beyond Prior Authorization: 4 Ways to Control Specialty Drug Costs

By Matthew Hawley & Jonathan Starr PharmD – A patient receives automatic refills from a specialty pharmacy for a drug he no longer uses and ends up stockpiling $1 million worth of medication. A pharmacy miscalculates the number of units of a specialty drug prescribed for a patient, resulting in a claim that is $16,000 higher than necessary, yet the claim is paid for by insurance.

Read More

13 Areas to Improve Electronic Prior Authorization

By Alex Baker & Michael Wittie – In January 2022, ONC issued a Request for Information that sought public input on the ONC Health IT Certification Program and how it could incorporate standards, implementation specifications, and certification criteria related to electronic prior authorization.

Don’t Wait: Electronic Prior Authorization Can Relieve Burden Today

By Richard Cohan – Since the 1960s, medical prior authorizations have established a system of checks and balances that help control the costs of medication, services, and procedures. While much has changed since those days, many challenges—such as cumbersome manual processes for payers and providers and delays in care for patients—have remained the same.