Navigating the complex role of Prior Authorizations (PAs) presents formidable challenges to patient care and reimbursement strategies. Stakeholders contend with evolving regulations, escalating costs, and intricate reimbursement processes while striving to optimize provider pathways.

The current reality demands immediate action. Medicare mandates comprehensive data retrieval within three years, with legislative changes to reform the PA landscape by January 2027. Until these changes materialize, stakeholders must grapple with existing complexities. It is within this context that the role of HUBs becomes increasingly critical.

Addressing the challenges doctors face in processing PAs across numerous products, a proficient HUB enhances workflow by concentrating on a single product. COPILOT initiated a study to compare PAs’ completion rates with those of other companies and assess if execution affected PAs’ acceptance. In contrast to previous submissions by specialty staff, where 50% of tasks were inaccurately handled, COPILOT’s specialized experts achieved double approval rates. Leveraging proprietary PA libraries, our experts ensure precise capture and documentation of crucial clinical information, alleviating burdens that may have previously impeded office staff and contributed to low historical approval rates for new categories of drugs.

Situation

New Product launched* into a category where specialists are not accustomed to completing PAs. In the early months post-launch, COPILOT reviewed 135 previously submitted PA forms provided by 5 different HCP offices. The work was conducted because of market knowledge that over 50% of PA forms often are filled out incorrectly.** Industry survey revealed 36% approval rate and COPILOT wondered if their dedicated approach could be improved.

Results

COPILOT Achieved a 73% rate - more than double industry standard.

HOW? COPILOT aided offices by obtaining clinicals, transcribing, submitting, and following up on those PA forms to gather results.

COPILOT proprietary Prior Authorization (PA) libraries can review, capture, and document the required clinical information that overburdened office staff may have been unable to validate.