The Top Three Prior Authorization Issues Plaguing PBMs and Plans

Posted on: November 2, 2015 / By: Dan Horsey


Processing pharmacy prior authorizations (PA) efficiently is a major hurdle for pharmacy benefit managers (PBMs). An ineffective prior authorization program can prove costly on not only the formulary side, but on the administrative side as well. One of the main problems PBMs face are clunky and inefficient prior authorization systems. These systems waste precious time and resources due to their poor design. Some of the most common problems we see are:

  1. Systems designed by programmers, not pharmacists: Software engineers are good at writing programs, but they don’t know the PA process. PA software doesn’t face the public, and it shows. Users often stumble through the PA process in an awkward manner, completing steps out of order or missing them entirely. Programmers’ top concerns are getting the software built and selling it. Having it make sense to the average user? Maybe in the next update.
  2. Incomplete software: Modern PA software doesn’t have everything you need to complete a PA in one program. It’s like having to use separate calculators for both addition and subtraction. The list of medications a member is taking? That’s five clicks away on sub-menu F. His or her previous authorization history? That’s not even included. This means your users can spend more time on a PA request looking up information than they do completing it.
  3. Keeping up with requirements and regulations: Developing a PA program is one problem; keeping it up-to-date is another one entirely. Most programs let you make changes to the software to account for new regulation. That’s good, but that means every change in federal regulations is on you. Add in state-specific regulations for every region you serve, and you need an entire staff just so you don’t fall behind.

So how can you improve your prior authorizations? Try PerformPA. PerformPA is the only pharmacy prior authorization software designed, supported and used by pharmacists. PerformPA intuitively guides users through an efficient prior authorization workflow, organizing everything into a step-by-step interface that anyone can use. It contains all the information needed to complete a request in one simple program. And, because we use it every day at PerformRx, we keep it up to date with the latest regulatory requirements, so you don’t have to worry.

Want to learn more? Contact us for a demonstration or learn more here.