RE: Prior Auths

[Guest guest]

Please don't take this statement personally.

But there are technicians who are approving/disapproving prior auths? What

type of information do they provide to you?

I'd have thought it'd be nurses/doctors/pharmacists approving/disapproving

prior auths. Not because CPhT's don't know their information (because many

do know a lot!) but because without adequate education (IE: why and how the

drug does what it does, what the difference is between different drugs of

the same class, etc), I honestly can't see a number of the technicians that

I've worked with (of course some of them are ditz') havig the 'power' to say

yes or no on a prior auth.

Again, don't take this question personally. I just got up, have a headache

(dangit, I knew I shouldn't have had that glass of wine last night!), and am

scheduled for my 9am to 9pm day today.

Della

(Pharmacist since July 03, Technician most of her life)

Cat Haven, Inc

A No-Kill Cat Rescue (501c3)

Houston, Tx

www.cat-haven.org

Prior Auths

Hello Everyone,

I graduated in May and received my Ca. Tech licensed in June. I finally got

a job with PCN. My job is processing Prior Auths not at the pharmacy but to

approve or dissaprove them. Is there any advice I can get on this. Some

basics that will really help me out in learning the process. Any help would

be great.

Thank Yuo

Dan

[Guest guest]

Dear Della,

I do not know Dave ( I do not think any way) , but a few of my students are also

getting positions in prior auth, with Prescription Solutions and and Wellpoint.

They hire techs BECAUSE they know and understand the drugs and names on a

'basic' level compared to the average 'joe' off the street that they were hiring

before. The tech is the one who 'screens' the call for the pharmacists that are

also part of the prior auth team. The tech will help the other tech or RPH on

the other end (store) of the phone to get the script adjudicated... Some times

it is a 'no coverage' problem that does not require a pharmacist, or a " you put

in the wrong character- you needed a : but you entered a ; "

problem, and of course many others. When it comes to substitution there are two

ways:

A formulary of drugs covered with trade/generic/classifications that the prior

auth tech verbally gives to the store pharmacist: the Prior Auth tech speaks to

a pharmacist from the store and tells the RPh what drugs CAN BE subsittuted per

the plan. The prior auth techs READS from the approved insurance list. The RPh

on the other end of the phone(store) KNOWS if this list is acceptable in terms

of pharmaceutics or pharmacologically interchangeable. IF the RPH has a question

then the prior auth tech gives the phone call to the Prior Auth Pharmacist to

handle. If the store RPh Accepts the list that the prior auth tech

'read'/provided, then he/she uses that substitutuin drug as a dispense drug or

confers later with the doctor about proper substitution per insurance plan and

prior auth info provided by prior auth tech per store policy or as indicated by

the store pharmacist. If the prior auth RPh can not change or help the store

pharmacist I do not know what happens then, because my

students are not Prior Auth RPh's, and they usually never know the outcome of

such calls, because they have 'moved on' to another call to trouble shoot it.

They are on a timed limit per call also and have goals to answer questions

efficiently and within a specific amount of time. Quotas.

Prior Auth techs MUST be able to be courteous and handle the problems

efficiently. My students have been further trained at such prior auth companies

to handle specific types of quesitons and how to look up various insurance

plans. Prior Auth techs must also be able to KNOW their limitations. They do not

make substitution lists themselves, rather provide the list verbally to the

pharmacist who is on the other end of the phone. BUT they MUST know the

trade/generics and classifications very very well. They must also know drug

interactions well. Why???? because they themselves MAY find an error on the list

that someone else (pharmacists or a Pand T committee) have made for a specific

plan and while reading the list to a store pharmacist may see an error and then

pass the phone to the prioro auth pharmacist for trouble shooting.

Prior Auth Techs are trouble shooters and screeners. They do not make decisions,

other than to passthe phone to a Prior Auth pharmacist. They basically follow a

format and are trained what is in their realm or not. On the other end of the

phone is usually a tech or a pharmacist. If it is a drug subst question some

prior auth companies have techs automatically give the call to a prior auth

RPH, others allow the prior auth techs to give the substitution list over the

phone to the RPh. Again they did not make a decision, but merely provided

pre-approved information.

Now it is up to the store pharmacist to know if there is still a problem with

the substitution list provided by the prior auth tech or if it conflicts with

meds the patient is currently on or a condition that the patient has or other

pharmacological reason. Therefoe it is the responsibility of the calling/store

pharmacist to ask for a prior auth pharmacist.

Hope this helps both you and Dave out....

Would love to hear from other experienced prior auth techs!!!

Respectfully,

Jeanetta Mastron CPhT BS Chem

Pharm Tech Educator

Founder/Owner

Della Hengel <hengel@...> wrote:

Please don't take this statement personally.

But there are technicians who are approving/disapproving prior auths? What

type of information do they provide to you?

I'd have thought it'd be nurses/doctors/pharmacists approving/disapproving

prior auths. Not because CPhT's don't know their information (because many

do know a lot!) but because without adequate education (IE: why and how the

drug does what it does, what the difference is between different drugs of

the same class, etc), I honestly can't see a number of the technicians that

I've worked with (of course some of them are ditz') havig the 'power' to say

yes or no on a prior auth.

Again, don't take this question personally. I just got up, have a headache

(dangit, I knew I shouldn't have had that glass of wine last night!), and am

scheduled for my 9am to 9pm day today.

Della

(Pharmacist since July 03, Technician most of her life)

Cat Haven, Inc

A No-Kill Cat Rescue (501c3)

Houston, Tx

www.cat-haven.org

Prior Auths

Hello Everyone,

I graduated in May and received my Ca. Tech licensed in June. I finally got

a job with PCN. My job is processing Prior Auths not at the pharmacy but to

approve or dissaprove them. Is there any advice I can get on this. Some

basics that will really help me out in learning the process. Any help would

be great.

Thank Yuo

Dan

[Guest guest]

Dan,

Thanks for the reply. As I was thinking more about it on the way to work, I

know it makes sense to use Pharmacy Technicians as Prior Auth contacts.

But my brain was more along the lines of: But since technician's can't

counsel (IE: make judgement calls) in most states, then they can't just out

and out approve a Prior Auth unless it's by a collaberative practice

agreement. IE: There are some doctors and pharmacists that have

collaberative practice agreements where the Doctor may write a script that

just gives a diagnosis, then the patient takes the prescription to a

specific pharmacy/pharmacist, who has a formulary that the doctor has agreed

to work from and the pharmacist can pick which drug (from the list that the

pharmacist and doctor agreed upon) they feel will work best for this

specific patient.

From what you wrote below, it does make sense. I'm just not always the best

person bright and early. I try to always be polite and considerate of

othes. That's why I made the point of asking for you to not take it

personally, as my questions, comments, whatever on many of the email lists

are not intended to be personal. If I can't figure out a way to phrase it,

I try to add the " don't take this personally " statement.

But thanks again for the info. I'm glad they ARE getting folks who at

least have some medical/pharmacy knowledge to help out with this. It's

annoying to get someone in a Prior Auth department that doesn't know didly

about the drugs.

Della.

Cat Haven, Inc

A No-Kill Cat Rescue (501c3)

Houston, Tx

www.cat-haven.org

RE: Prior Auths

Della,

From what I was told in the interveiw was that we have guidlines to follow.

The person interveiwing me told me that they always try to approve the Auth.

We do have Pharmacist to consult if the drug is perscribed for something

thats not in the guidelines for that specific drug. I haven't started my

training yet, but it seemed to me that they have everthing documented and we

research the info and follow those guidlines. Thank you all for your help.

I love this website!!!

Dan

[Guest guest]

Dearest Della,

One of the things I am most proud of on this site is the fact that the members

of this site are very courteous of each other. Rarely do we have a situation of

a post being taken the 'wrong way' or too personal. But then again this site

is more geared towards factual stuff with study and all. Be when we diverge into

opinion it has been very fortunate to have all opinions respected even when we

have disagreed.

Once again thank you for your question and input. Iappreciate your service s the

ResidentPharmacist NO END!!! I count my blessings every day that YOU are here

and care!

Respectfully,

And With Love and Appreciation for all that you do.....

Jeanetta Masttron CPhT

PS I am not good early morning either!

Della Hengel <hengel@...> wrote:

Dan,

Thanks for the reply. As I was thinking more about it on the way to work, I

know it makes sense to use Pharmacy Technicians as Prior Auth contacts.

But my brain was more along the lines of: But since technician's can't

counsel (IE: make judgement calls) in most states, then they can't just out

and out approve a Prior Auth unless it's by a collaberative practice

agreement. IE: There are some doctors and pharmacists that have

collaberative practice agreements where the Doctor may write a script that

just gives a diagnosis, then the patient takes the prescription to a

specific pharmacy/pharmacist, who has a formulary that the doctor has agreed

to work from and the pharmacist can pick which drug (from the list that the

pharmacist and doctor agreed upon) they feel will work best for this

specific patient.

From what you wrote below, it does make sense. I'm just not always the best

person bright and early. I try to always be polite and considerate of

othes. That's why I made the point of asking for you to not take it

personally, as my questions, comments, whatever on many of the email lists

are not intended to be personal. If I can't figure out a way to phrase it,

I try to add the " don't take this personally " statement.

But thanks again for the info. I'm glad they ARE getting folks who at

least have some medical/pharmacy knowledge to help out with this. It's

annoying to get someone in a Prior Auth department that doesn't know didly

about the drugs.

Della.

Cat Haven, Inc

A No-Kill Cat Rescue (501c3)

Houston, Tx

www.cat-haven.org

RE: Prior Auths

Della,

From what I was told in the interveiw was that we have guidlines to follow.

The person interveiwing me told me that they always try to approve the Auth.

We do have Pharmacist to consult if the drug is perscribed for something

thats not in the guidelines for that specific drug. I haven't started my

training yet, but it seemed to me that they have everthing documented and we

research the info and follow those guidlines. Thank you all for your help.

I love this website!!!

Dan