Stephen Marmaras, director of policy and advocacy for the Global Healthy Living Foundation, discusses the challenge of prior authorizations.
Transcript:
How would you like to see prior authorizations change to reduce the burdens for patients and physicians?
When we talk to physicians that treat patients with many of the chronic, complex diseases that make up our community, they tell us that it’s maddening the diversity of prior authorization forms. Unfortunately, many of them tell us it’s only the offices that devote full-time staff to prior authorization forms where you see patients getting the drugs that their physicians prescribed.
We think that that’s just an absolutely ridiculous system where patients are only receiving the drugs their doctors prescribed because there’s staff on hand to process forms. So, what we’d like to see done is have more legislation pass that requires uniformity of prior authorization forms. Florida took a massive step forward in doing that last year, but I think there’s still more reform efforts that need to be undertaken.
I think we need to apply some penalties to that type of legislation, so that if insurers are found to not be in compliance with standardization of prior authorization forms that there’s some sort of monetary penalty for doing that, per instance, not for a totality. It’s really critical that insurers are talking to physicians. I think that physicians need to be engaged really on a focus-group level in state—specifically in-state, talking with the specialists in-state or even general practitioners to some degree—to get an understanding of what are the major hurdles and barriers in the prior authorization forms that currently exist.
I think that a lot of times there are no answers to those questions and those conversations haven’t been had. They need to occur. We’d love to help them occur, we’d love to connect insurers in states with specialty physicians that we know have had difficulty, and their patients have had difficulty, with processing prior authorization forms.
But we should never live in a world where a person with a chronic disease can’t get access to a drug because their doctor or staff hasn’t or can’t fill out a form correctly or doesn’t have the time to fill out a form because it’s so onerous.
PBM Evolution Toward Value-Based Care Shifts to Transparent Pharmacy Pricing
March 30th 2025Josh Canavan, PharmD, RazorMetrics, and Chris O'Dell, Turquoise Health, predict pharmacy benefit managers (PBMs) will evolve toward value-based care, mirroring the broader shift toward open-cost structures.
How AI Can Help Address Cost-Related Nonadherence to Biologic, Biosimilar Treatment
March 9th 2025Despite saving billions, biosimilars still account for only a small share of the biologics market—what's standing in the way of broader adoption and how can artificial intelligence (AI) help change that?
Empowering Vulnerable Populations: The Path to Equitable Biologic Therapy Access
December 22nd 2024Elie Bahou, PharmD, senior vice president and system chief pharmacy officer at Providence, discusses strategies to improve equitable access to biologic therapies, including tiered formularies, income-based cost sharing, patient assistance programs, and fostering payer partnerships.
Biosimilars in America: Overcoming Barriers and Maximizing Impact
July 21st 2024Join us as we explore the complexities of the US biosimilars market, discussing legislative influences, payer and provider adoption factors, and strategies to overcome industry challenges with expert insights from Kyle Noonan, PharmD, MS, value & access strategy manager at Cencora.
Can Global Policies to Boost Biosimilar Adoption Work in the US?
November 17th 2024On this special episode of Not So Different honoring Global Biosimilars Week, Craig Burton, executive director of the Biosimilars Council, explores how global policies—from incentives to health equity strategies—could boost biosimilar adoption in the US.
Q&A With Dr Chelsee Jensen: Navigating FDA Approvals, Challenges in the Biosimilar Landscape
January 14th 2024Chelsee Jensen, PharmD, BCPS, senior pharmacy specialist and pharmaceutical formulary manager at Mayo Clinic, reacts to the biggest FDA approvals of 2023 and how she sees the adalimumab, natalizumab, and tocilizumab spaces playing out.
PBM Evolution Toward Value-Based Care Shifts to Transparent Pharmacy Pricing
March 30th 2025Josh Canavan, PharmD, RazorMetrics, and Chris O'Dell, Turquoise Health, predict pharmacy benefit managers (PBMs) will evolve toward value-based care, mirroring the broader shift toward open-cost structures.
How AI Can Help Address Cost-Related Nonadherence to Biologic, Biosimilar Treatment
March 9th 2025Despite saving billions, biosimilars still account for only a small share of the biologics market—what's standing in the way of broader adoption and how can artificial intelligence (AI) help change that?
Empowering Vulnerable Populations: The Path to Equitable Biologic Therapy Access
December 22nd 2024Elie Bahou, PharmD, senior vice president and system chief pharmacy officer at Providence, discusses strategies to improve equitable access to biologic therapies, including tiered formularies, income-based cost sharing, patient assistance programs, and fostering payer partnerships.
Biosimilars in America: Overcoming Barriers and Maximizing Impact
July 21st 2024Join us as we explore the complexities of the US biosimilars market, discussing legislative influences, payer and provider adoption factors, and strategies to overcome industry challenges with expert insights from Kyle Noonan, PharmD, MS, value & access strategy manager at Cencora.
Can Global Policies to Boost Biosimilar Adoption Work in the US?
November 17th 2024On this special episode of Not So Different honoring Global Biosimilars Week, Craig Burton, executive director of the Biosimilars Council, explores how global policies—from incentives to health equity strategies—could boost biosimilar adoption in the US.
Q&A With Dr Chelsee Jensen: Navigating FDA Approvals, Challenges in the Biosimilar Landscape
January 14th 2024Chelsee Jensen, PharmD, BCPS, senior pharmacy specialist and pharmaceutical formulary manager at Mayo Clinic, reacts to the biggest FDA approvals of 2023 and how she sees the adalimumab, natalizumab, and tocilizumab spaces playing out.
2 Commerce Drive
Cranbury, NJ 08512