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Help patients get the prescription drugs they need
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It’s a scenario that plays out all too often. You consult with a complex patient, perhaps at the request of a colleague or primary care physician. After listening intently and a careful examination, you provide a well-orchestrated management plan, the cornerstone of which is a specific therapeutic agent. The patient is in complete agreement with your recommendation, thanks you and heads to the pharmacy for their medication.
As you finish up the day and check in-basket communications, there is the dreaded correspondence. Your prescription was denied, as it requires prior authorization (PA). And you thought the problem was solved in the exam room.
At a time in which practitioners are inundated with intrusions and distractions – each an impediment to patient flow and quality care – perhaps none is more frustrating than PA. To many, PA seems like a roadblock, a “process” created to deter prescribing habits and, ultimately, deny patients the medicines they truly need. What galvanizes this notion is the lack of uniformity with PA. Each insurer employs a different tact – using its own forms, procedures and timelines, often arriving at a seemingly arbitrary decision. As cynical as it sounds, at times the PA process seems like a battle of attrition – testing the fortitude of practitioner and patient alike.
I’m not naïve and I fully understand the fundamental intent of PA. Prescription drug costs are a huge problem in the U.S. According to CMS, in 2015 we spent $325 billion on prescription drugs, just over $1,000 per capita. Kesselheim aptly points out this is just about double the per capita spend in 19 other industrial nations. At projected per annum growth of 4% to 7% over the next decade, prescription drug costs could easily exceed 2% of our country’s annual gross domestic product (CMS.gov).
How can this possibly be? Some of it is because prescription drugs play a substantial role in increased life expectancy. Simply put, it’s the cost we pay for living longer. Other considerations are the exorbitant cost of FDA approval, the fact that big pharma shareholders expect an investment return, the proliferation in our retail drug store sector and the possibility that our pharmacy benefit manager concept has gotten a little sideways! Suffice it to say, the issue of skyrocketing prescription drug costs is multifactorial, with a lot of variables at play. The question for each of us is simple: Are we part of the problem or are we doing our share to contain costs?
If you’ve read just even one of my editorials, you know I’m big on patient advocacy. Every day we commit to providing optimal care – be it vision correction, medications, surgery or even PA. The challenge lies in doing so in the face of increasing time constraints and the complex nature of eye care. It’s tough enough to be an adept clinician, much less an expert in PA. Unfortunately, as a vehicle of cost containment, PA is here to stay and we must efficiently and effectively deal with it. This month’s feature article, “Clinicians provide best practices for helping patients access medications” provides tremendous guidance in this area. Drawing on the expertise of optometric and industry colleagues alike, it provides effective strategies for getting patients the prescription drugs they need. I’m confident their advice will make your days a bit less stressful while exemplifying your commitment to patient advocacy ... well beyond the exam room.
- Reference:
- Kesselheim AS, et al. JAMA. 2016;doi:10.1001/jama.2016.11237.