PH专业网络:肺动脉高压药物事先授权的负担:管理过程的实用指南

Traci Housten, Anna M. Brown
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引用次数: 4

摘要

治疗肺动脉高压(PH)的药物价格昂贵,通常需要事先获得保险支付人的授权。提交事先授权请求和对拒绝提出上诉的任务可能会给PH诊所带来沉重的工作量,并延误或中断医疗。然而,通过实施用于管理事先授权流程的标准办公室工作流程,可以减轻这种负担,提高成功率,并减少等待时间。这一系统涉及几个关键组成部分:对现有工作人员和专业知识水平的评估;专职办公室工作人员自始至终监督这一过程;简化患者文件的收集、存储和传输;与药店和风险评估缓解战略项目的直接沟通;仔细记录特定患者的PH诊断和治疗计划,以减少上诉的必要性。本文回顾了PH诊所使用的事先授权策略和系统,以及其他治疗领域的案例研究,这些研究证明了这些系统如何在提高成功率的同时减少工作人员的时间和药物开始的等待时间。这篇文章还描述了为儿科患者开具的PH药物申请事先授权的特殊挑战。
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PH Professional Network: The Burden of Prior Authorization for Pulmonary Hypertension Medications: A Practical Guide for Managing the Process
Medications for pulmonary hypertension (PH) are expensive and often require prior authorization from insurance payers. The task of submitting prior authorization requests and appealing denials can burden PH practices with a heavy workload and delay or interrupt medical treatment. However, it is possible to reduce this burden, improve success rates, and reduce waiting times by implementing a standard office workflow for managing the prior authorization process. Such a system involves several key components: assessment of existing staff and level of expertise; dedicated office staff to oversee the process from start to finish; streamlined gathering, storage, and transmittal of patient documents; direct communication with pharmacies and Risk Evaluation Mitigation Strategy programs; and careful documentation of PH diagnosis and treatment plans for a given patient, aimed at reducing the necessity for appeals. This article reviews prior authorization strategies and systems used at PH clinics, and case studies in other therapeutic areas that demonstrate how such systems can reduce staff time and waiting time for initiation of medications while improving the rate of success. The article also describes the special challenges of requesting prior authorization for PH medications prescribed to pediatric patients.
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