Prio-Authorizations: The Rainbows and The Thunderstorms
Hey Everybody! Before I get going down the road of Prior-Authorizations let me introduce myself and give you a little background on who I am. My name is Hannah Fine and I have been a Pharmacy Technician since 2011. I currently work at UVA Specialty Pharmacy as a Medication Authorization Technician. I specialize in Spinraza, Emflaza, and Exondys-51 Medical/Pharmacy Authorizations, and I also help to support the Pediatric Outpatient Clinics in doing pharmacy auths for specialty and non-specialty medications.
My career began in the retail setting working for CVS for the first 6 years of my career. After CVS I worked for a Dermatology Practice as a Medical Technician. While at the Dermatology Practice I supported our 3 Providers doing medication Prior-Authorizations, documenting office visits, and assisting in biopsies and skin cancer removal surgeries. After leaving the Dermatology Practice I started working for UVA as an Access Associate. While in this position I did registration and I also helped to resolve scheduling issues for patients in the clinic. I was in that position for a year and I saw my current position open up and decided to apply since I had some Prior-Auth experience, and now I have been with UVA Specialty for just over 2 years.
Now we can get started on the amazing and sometimes frustrating world of Prior-Authorizations, specifically Spinraza Prior-Auths. If you have never heard of or read up on Spinraza let me give you a brief background on why this drug is so difficult to get authorized. It’s $125,000 per dose for LIFE for Spinal Muscular Atrophy patients, and due to the cost alone insurance companies cringe at the sight of a Prior-Auth request. Do you blame them though? I absolutely don’t, so that is why I give them no choice but to approve this for my patients. I am going to specifically talk about and refer to the process of my Spinraza authorizations, so buckle up and hold on for the roller-coaster ride that is my everyday like at work.
“It’s a complicated and intertwining world of multiple transfers, holds, and unanswered questions that make you feel like you have run into a brick wall hundreds of times.”
If you are reading this as somebody who does not submit Prior-Auths on a regular basis just go ahead and throw everything you think you know out the window. It’s a complicated and intertwining world of multiple transfers, holds, and unanswered questions that make you feel like you have run into a brick wall hundreds of times. Just when you think you have figured it out you are met by another insurance barrier that seems to have popped up out of thin air, this is where that thunderstorm from the title comes in. You feel like giving up and backing down, but this is not the time to take the path most traveled guys. Get out your umbrella and keep weathering the storm no matter what excuses you are given. I have had everything from I did not check the right box, they only received the form and no clinical documentation, they just got the cover letter (this is my favorite one! How did you even start the process if you only got the cover letter?), and countless others that I can’t even remember. This is where backup comes in handy!
I am lucky enough to work closely with the manufacturer of Spinraza and the reps that cover my territory. If I get an answer I don’t like from the insurance company, I will reach out to the family access manager and they reach out to their connections and find me the right answer. It truly takes a team effort to make these things work. Pharmaceutical company reps are not your enemy in these types of situations, they are a true ally that understands your frustration. They understand that the drug isn’t cheap and that it takes work to get these things approved and patient assistance on the books. We all have the same end goal here guys, healthy patients on treatments that work best for them. Don’t build a wall when you can build a bridge that benefits you, the patient, and the pharmaceutical company in the long run. Granted not all companies provide these kinds of resources or even the willingness to help, but they know if it’s expensive they need these resources for sites of care.
Once you finally get that approval and are able to let the provider and the family know that a life-saving treatment is approved and will start in the near future, it is the rainbow after the storm. Hearing the gratitude, and even sometimes tears, makes it all worth it. Knowing your effort, passion, and unwillingness to take no for an answer is going to help improve the quality of life is like no other.
Keep pushing on through the thunderstorms and find your rainbow guys!
