DALLAS, August 31, 2022 – Today, CerpassRx, a Texas-based pharmacy benefit management company, announced their new Proactive Prior Authorization Process.
**PROBLEM** The American Medical Association has found that 94% of doctors say their patients have experienced delays in care due to prior authorization and 30% say the process has led to a serious adverse event for a patient in their care.
**SOLUTION** CERPASSRX PROACTIVE PRIOR AUTHORIZATION. How does our prior authorization program differ from our competitors? It all starts with our core company values of Collaboration, Accountability, Passion, and Empowerment.
- Collaboration: The prior authorization (PA) process is imperative for all stakeholders involved (provider, member, pharmacy, etc.). CerpassRx uses a PA method that aligns with our sharp focus on a positive member experience. Our dedicated staff is trained to address all member, pharmacy, and physician inquiries; providing a collaborative product used to streamline the process by reducing challenges while also adding value to the member.
- Providers and Pharmacies: Our automated PA system is directly connected to the CerpassRx call tracking module housed within the adjudication system. This connectivity allows for general or drug-specific clinical PAs to be sent to the prescriber when the pharmacy receives a reject message indicating a need for a PA. Our PA system tracks the progress of each individual’s clinical PA as it progresses through a standard set of time-sensitive steps.
- Members: Our turnaround time for a clean PA review is currently less than 24 hours (exceeding the industry standard of three to five business days). This method often overcomes challenges and helps to prevent any unnecessary delays for the members treatment.
- Accountability: CerpassRx is held accountable to maintain high standards. To ensure appropriate utilization and drug spend management, our PA process provides a unique disruption decrease methodology for members that focuses on enhancing services and tools to result in minimal disruption of member access toward drug coverage.
- Passion: CerpassRx recommends a small and focused list of products where the PA process yields the greatest value (<1% of claims by volume). A drug that has a high or low approval rate may be a poor candidate for PA review. Other PBMs opt to overutilize the PA process and their approval rate is very high resulting in the PBM charging for a review that is causing unnecessary disruption without delivering any value. CerpassRx’s approval rate for 2021 was 61.5% and 66.7% for 2022, highlighting the value of our clinical review process.
- Empowerment: We empower our members by establishing a proactive PA process for members who are continuing therapy. We proactively identify members who have an active PA on profile set to expire within 30 days. To initiate review and avoid disruption in therapy, the members case is sent to the prescribing provider prior to the expiration of the PA. This process eliminates any future disruption/delay while still maintaining the integrity of the clinical review process.
CerpassRx transformed the PA experience, providing members with tactful and precise services.
CerpassRx is a leading pharmacy benefit management company based in Dallas-Fort Worth, Texas. CerpassRx provides clients with innovative, flexible, and unsurpassed pharmacy benefit management services.