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Improving Speed to Therapy.
One PA at a Time.

The prior authorization process has always been fraught with inefficiencies and inaccuracies. Until now. DrFirst delivers accurate patient benefit information from payers directly to providers within their workflows.

At Long Last, Relief From PA Friction

Patients need access to appropriate medical care and medication therapies without delays. DrFirst partners with its payer clients to deliver accurate, real-time medical and prescription benefits within EHR workflows to make the PA process more efficient, eliminate the possibility of duplication of effort, and in some cases, even eliminate the need for prior authorization altogether.

Price Transparency Solutions - DrFirst

Prior Authorization Solutions

DrFirst solutions bring payer benefit information to providers to overcome prior authorization challenges.

We need to dramatically reduce unnecessary PAs—and expedite the ones that are required—to help providers accelerate care.

According to a 2019 study by the American Medical Association, more than two-thirds of physicians reported difficulty determining if a medical service or prescription required a PA. Because PAs can consume 14.9 hours/week of staff time, eliminating unnecessary PAs is vital to all stakeholders.

CareComplete offers a quick code lookup that automates the verification process at the point of care. If a submission is required, EHR-populated electronic PAs eliminate portal logins and reliance on faxes. Submission status updates are delivered within the workstream.

Our real-time response eases the PA burden, enables providers to file quickly or delegate the responsibility, and dramatically reduces call center activity. And your members get timely care including price and location information.

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Our formularies can change based on payer and Medicare requirements. We need to keep accurate information in front of providers to avoid the risk of penalties.

A 2019 American Medical Association survey revealed that, on average, a medical practice completes 29.1 prior authorization requirements per physician and takes almost two full business days to process. Not only does understanding these requirements take an excessive amount of staff time, but 92 percent of physicians also reported that the process delays patient access to care and 78 percent of providers said that patients abandoned a recommended course of treatment altogether. The amount of time a PA takes can be exacerbated significantly when the formulary information is out of date or inaccurate.

Formulary accuracy, including prior authorization requirements, is essential to the value PBMs deliver to payers, providers, and patients. CareComplete presents up-to-the-minute PBM- and payer-specific drug information to clinicians at the point of prescribing to help patients get timely access to provider-preferred medications. With real-time prior authorization and step therapy guidance built into the process, electronic prior authorizations can help patients get their medications up to 13 days sooner.

And, formularies maintained and presented in real-time mitigate the risk of fines and align with CMS’ requirements for higher Star ratings and better patient satisfaction.

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If providers don’t have the information they need to complete a prior authorization accurately when they are prescribing our therapy, they may substitute my brand with another drug.

Prior authorizations can have a huge impact on whether or not patients get your brand drug as prescribed by a provider. A recent American Medical Association survey showed that 21% of prescribers avoided a drug with a prior authorization when an alternate, prior auth-free drug option was available. CareComplete’s real-time prior authorization solution presents more accurate electronic prior auth information, including prescribing education, to physicians when they need it – at the point of prescribing. And that means a greater likelihood that your brand will be dispensed as written.

 

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The best way we can help providers fulfill their value-based care contracts is by providing them with real-time prior authorization information that accelerates access to care for their patients.

Increasingly, payers are using prior authorization and step therapy as a method to help control healthcare costs. In fact, about 86 percent of physicians feel that the prior authorization burden has increased significantly or somewhat over the last five years. Without accurate requirements presented to providers at the point of prescribing, the results can be catastrophic. According to a recent survey by the American Medical Association, 24 percent of physicians said that prior authorization has led to a serious adverse event for a patient and 16 percent also said that prior authorization had led to a hospitalization.

To provide the utmost value to its clients, EHRs/HIS’ must invest in strategic functionality that assists providers in complying with contracts and getting their patients timely access to the care they need.

CareComplete offers a quick code lookup that automates the verification process at the point of care. If a submission is required, EHR-populated electronic PAs eliminate portal logins and reliance on faxes. Submission status updates are delivered to the workstream.

Our real-time response eases the PA burden by enabling providers to file quickly or delegate the process to a staff member. And patients get timely care with price and location.

 

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