Tricks to alleviate prior authorization struggles

Key takeaways:

• To speed up the prior authorization course of, physicians may use the digital prior authorization system and/or prepare extra employees members.
• Profitable prior authorizations require shut consideration to element.

SAN DIEGO — Getting prior authorization for drugs generally is a battle in allergy and bronchial asthma care, however creating templates and listening to element can pace up the method and result in extra success, based on a presentation right here.

Priya J. Bansal

“I’ve 120 paperwork in my prior authorization bin always,” Priya J. Bansal, MD, FAAAAI, FACAAI, allergist and immunologist at Bronchial asthma and Allergy Wellness Heart in Illinois, college member at Northwestern Feinberg College of Medication and consulting medical editor for Healio’s Girls in Allergy, mentioned on the 2025 American Academy of Allergy, Bronchial asthma and Immunology/World Allergy Group Joint Congress.

“I don’t assume it issues whether or not you’re in teachers, whether or not you’re in a hospital-based system otherwise you’re [in] solo apply — all of us are going through this burden proper now,” Bansal added.

To assist physicians within the “elusive” world of prior authorizations, Bansal supplied a number of ideas that may assist them be extra environment friendly throughout this course of.

In her first tip, “know the payors criterion for every of the drugs you file for,” Bansal recommends creating templates for every drug, which can enable physicians to shortly fill in blanks somewhat than ranging from scratch every time.

Based on Bansal, a template for a brand new bronchial asthma biologic begin ought to reference {that a} affected person is maximized on a excessive dose ICS/LABA, that they’ve failed a number of rounds of a steroid, their ACT rating and the biologic they might profit from.

Notably, affected person IgE stage, eosinophil depend and high quality of life survey scores (Urticaria Exercise Rating [UAS-7] and Investigator International Evaluation [IGA]) may additionally have to be included when submitting for biologics, Bansal mentioned.

Bansal’s second tip is “don’t submit a previous authorization you realize will fail.”

To stop this from taking place, physicians ought to rigorously learn the prior authorization’s necessities, which Bansal notes might comprise a remedy that the affected person should fail earlier than protection, forward of submitting the shape.

Different ideas for rushing up the prior authorization course of embody utilizing the digital prior authorization system, coaching a number of employees members and utilizing a digital medical assistant, based on Bansal.

Bansal additional famous that profitable prior authorizations would require shut consideration to element.

“Make sure that to have the prognosis code appropriate for the merchandise you might be submit[ting],” Bansal wrote on her presentation slide. “[Additionally,] make sure that insurance coverage is up-to-date and their identify matches in your system and on their insurance coverage card.”

If a previous authorization is denied, Bansal highlighted 4 measures that physicians can take: peer to look, enchantment, exterior evaluate and sending letters.

Understanding that prior authorizations can negatively influence allergy and bronchial asthma care by delaying it, advocacy is crucial, based on Bansal.

“Push again with native and state insurance policies and ensure the timeline is addressed for a extra speedy turnaround,” Bansal wrote on her presentation slide.

Notably, Bansal highlighted that physicians can share difficulties they face with prior authorization at advocacy@AAAAI.org.

“If you’re having these difficulties, others are as properly,” Bansal wrote on her slide.

For extra info:

Priya J. Bansal, MD, FAAAAI, FACAAI, may be reached at asthmaallergywellness@gmail.com.