SPEAKER SPOTLIGHT: Q&A

Q: Where you have you seen the most impactful changes to obtaining prior authorizations recently?
A: Modernization!, more and more insurers and PBMs are accepting online PA submissions. This is making managing requests much easier to submit and track. Also, we have seen more integration with EMRs and specialty pharmacies. One exciting change has been the manufacturer support programs setting up non-filling pharmacies as their hub. This makes the process of sending the eRx right from the EMR to the hub much easier. This way the patient can be screened for copay assistance much quicker, and the mandated pharmacy will get the eRx with the support information.

Q: When it comes to onboarding new biologic coordinators, what would you say is the most important aspect?
A:  The main focus is the approach. Understanding the process and how to apply it to the multitude of different therapies that are used in rheumatology. For new BCs the best advice is to familiarize your self with all the different conditions that are managed by the rheumatologist and then familiarize themselves with the therapies.

Some medications are used for multiple conditions and may have different induction doses or maintenance doses or may be available as an IV therapy or a self-injectable at home. They require different steps depending on the route of administration and can be confusing at first look, but understanding the differences and knowing what resources to reference can make the difference between getting an approval or a denial on the first try. I try to make sure our BCs have the most up-to-date information to get patients on therapy quickly with out to many obstacles. When onboarding I like to make sure that they know there is always something we can do to try to find access and to not get discouraged if they get a denial. A denial can open up appeals and peer-to-peer calls, or support programs that can help get the denial overturned.

Q: What are you most looking forward to at RAN in October in Nashville?
A:  Nashville will be a great opportunity to hear insights from other biologic coordinators, manufacturer support programs, insurances, and specialty pharmacies to better understand the PA process big picture.  I look forward to seeing what I can bring back to my workflow to help streamline the process. Hearing from every aspect of the process will help improve lines of communication and help shorten delays of therapy and help improve outcomes.

Q: What is the most rewarding aspect of your work?
A: Helping patients be able to access therapies that they thought insurance wouldn’t cover or that they thought they couldn’t afford. It can be stressful getting a denial letter or having the medication they are currently on be switched to something else. Working on it together along with provider can be an uphill climb but getting the patients what they need is incredibly rewarding.

Q: When it comes to summer vacations, do you prefer mountains or ocean?
A:  I enjoy both! Any time out of the office to reset and get back to it refreshed! I frequent Robert Moses Beach on Long Island in the summer, and enjoy hiking the mountains and lesser falls off Niagara in upstate New York.

Q: What specific music are you listening to these days?
A: Vivaldi’s ‘Four Seasons’ and anything on violin by Paganini, but when I need to get work done in the office, I’ll throw on some industrial techno or synthwave play lists!

Q: What are one of the most memorable places you’ve travelled to?
A: I was stationed in South Korea while in the Army, and enjoyed my time there immensely.

Q: What’s the last book you’ve enjoyed reading?
A: Anything by Aldous Leonard Huxley or Kurt Vonnegut

Q: What’s the quality you admire most in others?
A:  Dedication, I always strive to keep up to date on changes and trends regarding prior auths and enjoy discussions with others in the same field that are invested in being the best BC that they can be for providers and patients.