For practices that have created dry eye centers, no doubt the dedicated dry eye space isn’t big enough for the needs and requirements of all the stakeholders involved, starting with the patient and ending with the patient’s insurance company.
Everyone — patient, pharma, pharmacy, insurance company, provider — wants more than we all can seem to deliver.
Below I review the issues as we at Bowden Eye see them.
CREATE INTERNAL SYSTEMS
The following “Band-Aids” can assuage some of the chaos in your practice:
- Provide a handout to patients about the prescribing process. Dispel notions that the doctor electronically submits a prescription and it will be at the pharmacy when you drive there after your office visit. Ask patients to give the pharmacy some time for new medication prescriptions to be filled. Make sure the patient sheet instructs the patient to call the insurance company when it denies prescribed care. The patient pays premiums to the insurance company, so let the insurance company do its job. These companies hate patient calls.
- Designate a patient prescription advocate. Let correspondence go through one person per provider team (or one staff member) so that things don’t pass from person to person on your staff — which leads to patients feeling alone in the process.
- Learn about patient assistance programs. Many of the pharma companies have patient assistance programs that either provide samples to qualified patients or provide copay assistance. Have your “designated patient prescription advocate” learn about the programs and meet with those pharma representatives.
- Notify patients when you have completed steps. Examples: your practice sent a letter of medical necessity or copy of records, etc. Notify the patient and have a game plan when a drug is denied to that patient. The key to keeping the heat off the office is to keep the patient informed.
- Get your drug reps involved. They can assist with the processes because they know what formularies are being updated, what patient programs are available, and so on. Their paychecks depend on patients getting the drugs, so they can keep us updated.
Below is the handout that Bowden Eye gives its patients.
Prescriptions and insurance coverage
At Bowden Eye & Associates, our physicians pride themselves in providing you with the highest level of care possible. That care includes prescribing the best medication for your condition. We ask that the prescriptions be filled as written and that substitutions not be allowed as many of the substitutions do not fill the need as prescribed by your physician.
Due to all the changes in health care, many of the insurance companies are requiring prior authorizations for most proven medications prescribed daily. This may apply to your new prescriptions, as well as to your existing prescriptions.
Unfortunately, we cannot determine which of your prescriptions require prior authorization without first submitting the prescriptions to the pharmacy of choice. We ask that you call your pharmacy before pick-up to ensure that your medications are ready.
Once a prescription has been submitted to your pharmacy, the pharmacist will inform us if a prior authorization is required. At that time, we start the “prior auth” process and request for coverage. Once the request has been submitted to the insurance carrier, it can take up to a week before receiving an approval or in some cases a denial. We will contact you once the result of the authorization is received.
We understand that this may prolong your wait to get your medication started. We are dedicated to expediting the application and getting your prescriptions to you as quickly as possible.
As for the stakeholders:
Drug companies: Tell the drug representatives that your staff has: distributed product coupons and discount cards; enrolled the patients in the assistance programs; faxed exam notes and used the appropriate terminology and ICD-10 codes in the record.
What staff would appreciate from the drug reps: Visit the pharmacies and insurance companies as well. Topic of discussion: Eliminating all pharmaceutical and insurance input in the practice’s prescribing patterns.
The pharmacy and insurance company: Pharmacies need to figure out how to fill those providers’ prescriptions — in the best interest of the patient — following the physician’s written script. We tell the pharmacies to just fill the prescription and stop saying to the patients, “Look, Bowden didn’t send the script over.”
As for the insurance companies, putting new drugs on their formularies would help the pharmacies, and ultimately the patient. Also, providing a phone number for patients to call, instead of providing just an e-mail contact, would go a long way in terms of customer service.
Family members: Help your mother or father, uncle or aunt retain and absorb the information provided during the evaluation process.
Any handouts that the provider gives your family member at checkout are important to read because they are reminders that the providers are trying to get those prescriptions to the pharmacy so they are ready when you get there.
Please be supportive of the process and don’t get swayed by what your friends do for their dry eyes. OM
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