The main difference between Priority Authorizations and the biggest PA Service in the country is WHO controls the PA Request and the interaction with the payer.
If you are using a service to “cover your meds,” you are relying on a provider’s staff member to perform the request. This is typically done by someone who is not getting paid to do PAs, who is often extremely busy, and who has no idea if the patient has met the approval criteria for your drug or not. They fill out several drop down menus and complete an online request which can easily take 15+ minutes and which then often sits for up to 72 hours at most plans before it is even originally considered.
At Priority Authorizations, our team of trained pharmacy techs “takes over” for the office staff and controls the PA process. We place phone calls in real time to the plans, and we communicate the exact drugs that the patients have tried.
We know the approval criteria for your drug for each plan in the country, and in most cases, we know it much better than the plan representative with whom we’re speaking. We know before we submit the PA whether it has an acceptable chance of approval or not. If there are required drugs that have not yet been tried, we communicate that to the office.
It takes much more of that staff member’s time to fill out an online request than to refer the patient to us, and the likelihood of an approval is anyone’s guess. A staff member can usually provide us what we need to attempt the PA in less than 5 minutes.
Finally, our PA techs have been trained to work with whatever systems individual offices and payers have in place. If a plan requires an electronic PA Form submission, that’s what we submit. If they need an E-FAX followed by 2 phone calls, that’s what we provide. If a product is an Excluded Benefit for a given plan, we work to submit Letters of Medical Necessity with the providers to attain the approval. There is no “one size fits all” formula, and we will customize our offering to the needs of any client.
✔ Real time telephonic contact with payers
✔ Easiest, quickest interface for providers
✔ Industry-leading success rates
✔ Approval in less than 3 hrs in many cases
✔ Expert PA technicians
PA LLC Service Summary