How we Fixed our Pharmacy Prior Authorization Problem

Posted on: January 20, 2016 / By: Dan Horsey

PerformPA

It was in late 2008 when Mesfin Tegenu, President of PerformRx realized the problem wasn’t going away, it was growing. The prior authorization process at PerformRx used too many resources, and took too long. “We were tired of using multiple systems and slow processes to complete a single prior authorization,” said Mesfin.

Mesfin gathered a team to look around the market for solutions. He didn’t like what he saw. “We were kind of shocked when we looked around and saw that there wasn’t one tool that stood out. We already had the best product on the market, and it wasn’t working” said Mesfin.

After some deliberation, his team decided they could do it better. They knew from the start what they wanted. Andrew Maiorini, PharmD, Vice President of Clinical Programs described it perfectly. “We wanted a tool that was easy to use, would operate consistently and reliably, and would improve processes and efficiency,” he said. The solution was natural, to develop a tool that mirrored the natural progression of reviewing an authorization, and had everything you needed all in one end-to-end tool.

By 2009, PerformRx had implemented PerformPA®, the finished tool. “Immediately, I knew that we had a smash,” said Gerald Bonko RPh., Director of Pharmacy Utilization Management. Our associates agreed, the tool was easy to use, intuitive, and had few technical issues.  “Before PerformPA, we were completing roughly 40 prior authorization reviews a day, immediately after PerformPA, that number rose to 70” Gerry said.  

PerformRx has seen that number grow. Our efficiency has continued to improve even as we’ve expanded into new markets and seen increasingly complex benefit designs.  Each year, PerformRx is able to increase the efficiency of clinical operations by 5-10%. “It’s due to the scalability” Drew said. “The volume of prior authorizations has grown each year, and our clients’ benefits have grown more complex. However, our ability to process reviews has grown with it thanks to PerformPA.”

PerformPA has grown too. Through the years, PerformRx has added one touch audit functionality, advanced reporting, an automated web-based decision assessment tool (E-telligent) and other great features. That’s why today, they’ve decided to put PerformPA on the market for others to use. “The fact that it’s all right there, member eligibility, claim history, and benefit design make it so you never have leave the tool.”

To learn more, contact PerformRx at PerformPA@PerformRx.com or visit http://www.performrx.com/PerformPA.

Mesfin Tegenu, MS, RPh, is the president of PerformRx, LLC, one of the nation’s leading URAC-accredited pharmacy benefit management organizations

Andrew Maiorini, PharmD, Vice President of Clinical Programs, oversees formulary development, drug therapy management, pharmacy informatics/analysis and PerformRx’s prior authorization process.

Gerald Bonko RPh., Director of Pharmacy Utilization Management, is responsible for managing the efforts regarding clinical prior authorization and appeals operations as well as system development for all plans.

Dan Horsey is a Marketing Specialist that has been with PerformRx since 2009. He has previous experience in Medicare Part D compliance, pharmacy network management, and retail pharmacy.