Video: Every Case Tells a Story| Webinar: ACR/CHEST ILD Guidelines in Practice

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

Prior Authorization Struggle Continues

  |  Issue: May 2007  |  

Many Medicare Part D plans continue to request prior authorizations for several drugs commonly prescribed by rheumatologists. The ACR has been working diligently with Robert Bennett of the Physician Regulatory Issues Team (PRIT) to avoid the same problems many physicians had last year. PRIT advises all physicians to write “for Part D” along with the diagnosis on the prescription, to verify that the drugs are for Part D diagnoses and should not be paid under Part B. This way the administrators of the prescription drug plans (PDPs) can waive the need for a new prior authorization—saving time and money for physicians, pharmacists, and the PDPs.

Questions or concerns? Contact the ACR’s Melesia Collins, CPC, or Resaee Freeman, CPC, at (404) 633-3777, or PRIT at [email protected].

ADVERTISEMENT
SCROLL TO CONTINUE

Related Articles

    Medicare D-lemmas

    Rheumatologists and patients report mixed experiences with the new prescription drug benefit

    Medicare Switch to ASP Pricing Reduces Part B Spending

    The Medicare Payment Advisory Commission (MedPAC) reported to Congress in January that Medicare’s switch to a payment method known as ASP, or Average Sale Price, has reduced spending on drugs in the Medicare Part B program. This system reflects actual market spending, rather than wholesale prices.

    Medicare Drug Coverage Plans for Rheumatologic Medications

    Different parts of Medicare cover different services. For outpatient prescription drugs, Medicare has two distinct programs with a maze of complex policies. Most physicians along with Medicare patients, retail pharmacies, Medicare drug plans as well as Medicare Advantage health plans continuously struggle with navigating Medicare drug coverage under Part B and Part D. There are…

    Tips for Smoothing the Time-Consuming Prior Authorization Process

    ATLANTA—Obtaining prior authorization to ensure services or prescription drugs are covered by a patient’s health plan consumes staff time, and delays or denials may cause patients to abandon treatment, according to speakers at the 2019 ACR/ARP Annual Meeting. In a session on Nov. 10, the experts shared tips to smooth the process. Train Staff on…