OCULAR ALLERGY INSIGHTS … SPONSORED BY ISTA PHARMACEUTICALS

Not on the Formulary? Not a problem

When you prescribe BEPREVE® for relief of itching associated with ocular allergy, you can rest assured a team of managed care experts is ready to help obtain prior authorization if required

If you've ever written a prescription only to have it denied by a patient's insurance carrier, you know the frustration of trying to ensure that your patient receives the medicine you deem most appropriate to treat his/her condition. What's more, a request for prior authorization can disrupt the flow of your office, as your staff tries to fulfill the request in a timely manner. Not only does this take time, particularly if telephone follow-up is needed, but it also means your staff must be familiar with numerous insurance carriers' procedures and requirements. When you write for an ISTA drug, however, help is available.

ISTA Pharmaceuticals, Inc. has partnered with Apricot Medical Services, Inc., to provide assistance when a prescription for one of its products is denied. The ISTA Prior Authorization Line (PAL) program, which is free to physicians, provides a single form and a single portal to request prior authorization, regardless of insurance carrier. Because the process is simple and fast, and because 8 out of 10 submitted claims are approved, often within 24 hours, many physicians consider ISTA PAL an integral part of their practices.

ISTA PAL for BEPREVE

Among the physicians who rely on ISTA PAL are Triet Nguyen, MD, owner of Omnivision in Westminster, Calif., and Trung Nguyen, MD, owner of Advanced Eye Care Clinic in Fountain Valley, Calif. Both ophthalmologists use this service regularly to ensure their patients receive their first-line drug for itching associated with ocular allergy, BEPREVE� (bepotastine besilate ophthalmic solution) 1.5% [ISTA Pharmaceuticals, Inc.].

Since its introduction last year, BEPREVE has been added to many commercial insurance carriers' formularies � the overall reimbursement rate for BEPREVE is 93% with an average copay of $35 (which for the 10mL bottle provides 60 days of therapy) � however, both Dr. Triet Nguyen and Dr. Trung Nguyen note that some carriers denied coverage when the drug first became available, and a few restrictive plans still require prior authorization. Thanks to ISTA PAL, both physicians report that most denied prescriptions are approved quickly. In September, for example, in Dr. Triet Nguyen's practice, 33 of 36 claims were approved; and in Dr. Trung Nguyen's practice, 36 of 42 claims were approved.

"BEPREVE is my number one drop for itching associated with allergic conjunctivitis and it is important for me to ensure that my patients receive what I believe will work best for them," Dr. Trung Nguyen says. "ISTA PAL has been successful in getting more than 85% of denied BEPREVE prescriptions approved for my patients."

Dr. Triet Nguyen has himself tried to obtain prior authorizations for drugs in other therapeutic categories, such as glaucoma. "It's a frustrating experience," he says. "The pharmacy faxes an authorization request, which I must complete and fax back to them, and sometimes they actually ask me to make a phone call. One time, I was on hold for 45 minutes, and in the end, the prescription wasn't approved. It was just a waste of time."

Today, neither physician is involved in obtaining prior authorizations for BEPREVE. They write the prescription and their staff handles any denials through ISTA PAL.

Getting started with ISTA PAL

To register for ISTA PAL, which is also available for BROMDAY� (bromfenac ophthalmic solution) 0.09% and ISTALOL� (timolol maleate ophthalmic solution) 0.5%, prescribers complete a business associate agreement and authorize Apricot Medical Services, which is HIPAA compliant, to act as the practice's representative. The practice receives a username and password, allowing staff members to log on securely.

After a brief training session, staff members can manage most prescription denials and requests for prior authorization without involving the physician. They complete a simple, 1-page form, submit it to Apricot online or via fax, and the company negotiates with each individual insurance carrier to gain approval for the prescribed drug. According to Apricot, 55% of claims are processed within 24 hours, and 70% within 36 hours. To date, Apricot has provided prior authorization for more than 185,000 requests with more than 600 managed care payors.

Peace of mind and goodwill

Both Dr. Triet Nguyen and Dr. Trung Nguyen encourage physicians to take advantage of the ISTA PAL service.

"I have a large ocular allergy population," Dr. Triet Nguyen says. "I may see as many as 20 patients a day who are complaining about ocular itching associated with allergic conjunctivitis, many of whom have tried multiple allergy drops without relief. BEPREVE is now my number one choice for treating this symptom, and with the ISTA PAL program, I am assured that most patients will receive it. Using ISTA PAL is effortless on my part. It's a win-win."

Not only does ISTA PAL give these physicians peace of mind, knowing their patients are likely to receive the drug they prescribe, but it also creates goodwill among patients. As Dr. Triet Nguyen notes: "When we obtain approval for BEPREVE, patients are grateful that we went the extra mile for them. It increases their satisfaction with their care, which creates good will and helps build my practice."