HIMSSCast: Prior authorization as gatekeeper
The intent of prior authorization - to make efficient use of health resources - has not worked, says Peter Ax of UpScriptHealth.
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Prior authorization does not work for patients, providers or even payers, according to Peter Ax, founder and CEO of UpScriptHealth.
The intention of prior authorization is to make an efficient use of health resources, Ax said. It has not worked.
"Prior authorizations are hated universally by patients, by providers and frankly I don't think prior authorizations are helping payers achieve what they want to achieve," Ax said.
Telehealth pharmacy provider UpScript Health partners with pharmaceutical companies to get patients direct access to prescription drugs. The company has a buydown program to pay a fraction of the price for some drugs.
"Transparency is really the solution to the prior authorization problem, in my mind," Ax said.
For more, please listen to Ax's conversation with Susan Morse, executive editor of Healthcare Finance News.
Talking points:
- Patients are charged $35-$45 for a telemedicine visit.
- Fees paid by pharmaceutical companies to be on the company's platform make up a big part of the company's business model.
- Partners such as Amazon do prescription fulfillment.
- This year, UpScriptHealth booked half a million telehealth appointments.
- The direct relationship with drug manufacturers does not cut out PBMs.
- UpScriptHealth wrote its first online prescription in 2002.
More about this episode:
Prior authorization leads to serious adverse events for patients, AMA survey says
Prior authorization as a second opinion
Optum Perks eyeing Rx costs with telehealth solution
Medicare patients now eligible for Amazon RxPass
How pharma is connecting with digital health startups
Email the writer: SMorse@himss.org
