First, the patient advocate receives the oral treatment plan from the prescribing physician and performs a test claim. Next, she informs the pharmacy staff if prior authorization or patient funding assistance—or both—is required. “Most patients require both,” McDaniel said.
The patient advocate then communicates with the prescribing physician or nurse regarding whether the prescription can be filled in-house—or if the payer requires that it be submitted to another pharmacy. She also lets the patient know the co-pay amount and whether the prescription can be filled at the practice. If not, the patient advocate streamlines the submission of the prescription to the pharmacy mandated by the payer.
When it’s time for a refill, the patient advocate informs the nurse. If appropriate and the prescribing physician approves, the refill can then be handled by the practice pharmacy.
If an outside pharmacy is required by the payer, the patient advocate puts a note to that effect in the EMR—including any relevant information regarding prior authorization or patient assistance funding—to help ensure refills are managed smoothly and there’s no interruption in care.
“The Patient Advocate is definitely a full-service resource, from the time the oral treatment plan is written to managing prior authorization and patient funding assistance to monitoring and managing refills,” McDaniel said.