“It’s important to understand that covered doesn’t mean affordable,” said Mr. Turkas. He also warned that once a patient has switched from original Medicare to a Medicare Advantage plan, it is “almost impossible” to switch back.
Michelle Owen, a rheumatology office manager in Portland, Maine, with 15 years of experience, delivered the final presentation, addressing prior authorization. “I am the person who sits across from the patient to try to explain why their particular drug is not approved,” she said.
Ms. Owen strongly advised providers have a designated person in the office to handle all prior authorizations and to institute a process for automatic appeal for every prior authorization request that is denied.
She reminded the audience that physicians must write a detailed note on behalf of their patient for a prior authorization to go through. “If you’re willing to fight for it, I can get it … but I can’t get it if you don’t give me a good note,” said Ms. Owen.
Conclusion
Speakers at the ACR/ARP Access in Rheumatology meeting presented expert guidance on how to avoid or mitigate some of the field’s significant barriers to access, with information on biosimilars, navigating prior authorization, the buy-and-bill model and more.
Glen K. Rodman is the assistant editor of The Rheumatologist.
