SAN DIEGO — In the second year of Medicare Part D, physicians still struggle with prior authorization requests and other hassles, Dr. Kay M. Mitchell said at the annual meeting of the American College of Physicians.
For example, physicians still see requests for prior authorization and step therapy, said Neil M. Kirschner, Ph.D., ACP's senior associate of insurer and regulatory affairs. In addition, in 2007, several drugs were approved under both Medicare Part B and Part D, which could create denials, he said.
Officials at the Centers for Medicare and Medicaid Services recommend that physicians write the diagnosis and “Part D” on the prescription, Dr. Kirschner said.
Physicians might experience some relief in terms of prior authorization and exceptions if their patients haven't changed drug plans, said Dr. Mitchell, a geriatrician and a professor in the department of community internal medicine at the Mayo Clinic in Jacksonville, Fla. CMS officials said prior authorizations and exceptions approved by a drug plan in 2006 are expected to continue this year if the beneficiary is in the same plan and the expiration date hasn't occurred by Dec. 31, 2006. However, if the beneficiary changes plans, physicians might have to go through the same process again. And even if patients remain in the same plan, some physicians have still received prior authorization requests, she said. When faced with prior authorization, have the patient collect the authorization forms and bring them into the office, said Dr. Mitchell.
Some physicians have decided to deal with the extra Part D paperwork by hiring additional staff or designating staff to deal solely with Part D prior authorizations, denials, and appeals, Dr. Mitchell said. Dr. Mitchell prefers to have one of her nurses work on Part D issues because the nurse is already familiar with the patients and their medications. She also recommended staff members working on Part D issues attend continuing medical education meetings that focus on Part D.
Dr. Mitchell said that insurers may ask for documentation justifying a switch in medications. To simplify that process, she recommends, keep a sheet in the front of the chart with information on medication changes and the reasons for the switch.