Eighteen months ago, Beverly Andrews sometimes spent as much as half of her day in the Rheumatology Clinic at University of Colorado Hospital on the phone. She handled prescription refill requests from patients and also obtained prior authorization approvals from insurance companies for medications to treat rheumatoid arthritis, gout, osteoporosis, lupus and other rheumatologic diseases.
Important work, to be sure, but there was a big catch. Andrews is a nurse, not a pharmacist or pharmacy tech. She kept her commitment to quality patient care, but the medication-related phone time made it more challenging to do the work she was trained to do and complicated clinic scheduling. She wanted to dedicate more time to directly helping patients and answering their questions.
Throw me a line
Andrews and her nursing colleague Aubrey Blythe, RN, who joined the Rheumatology Clinic about a year ago, have reclaimed that time, thanks to the Pharmacy Department’s Medication Access and Renewal Center (MARC). Bridgette Nazareta, medication access specialist with the MARC, handles the clinic’s prior authorization requests (PARs), an often time-consuming task. The MARC’s Centralized Refill Center (CRC), meanwhile, takes care of prescription refills.
In doing so, the MARC meets a need that is not only specific to UCH but universal in today’s health care environment. Its staff ensures that patients get the medications they need without delay or interruption. That has also freed up patient-contact time for Andrews and Blythe to review plans of care and answer a host of clinical questions from patients with complex conditions.
“The MARC has given us a way to get back to spending more of our time on nursing,” Andrews said.
The clinic’s work with the MARC has also helped to free up its phone lines. Andrews and Blythe no longer have to regularly check the nurse message line that used to fill up with patients’ recorded questions, draining time from direct care.
“[Patients] talk to a live person now,” Blythe said.
Calls for refills are routed to the CRC. The improved efficiencies also allowed the clinic to take out a fax machine –a relic of another time.
Reading the fine print
It’s all added up to smoother operations and improved patient care and clinic access, said Duane Pearson, MD, associate professor of Rheumatology with the CU School of Medicine. “When our nursing staff is reviewing medication side effects and labs, that frees me up to see new patients,” he said.
Nazareta, who has worked with the Rheumatology and Endocrinology clinics for two years and is now one of a team of 20 serving a group of Ambulatory Services clinics, has been instrumental in the improvement. She automatically receives prescriptions written for 16 medications that require prior authorization. They are specified on an Automated Drug List that contains both the generic and brand names.
“After the provider writes the prescription for one of these drugs, I follow the whole process to make sure the patient has access to the medication and picks it up,” Nazareta said.
Her fundamental goal is to ensure that the prescription meets all the authorization criteria required by the patient’s insurance. If the information is not in the patient’s medical chart at UCH, Nazareta asks the provider for it. If the missing pieces aren’t in the hospital’s medical record, she contacts the patient directly or coordinates with his or her referring physician’s office to get what the insurer needs.
“We want to make sure that the prior authorization submission has everything necessary,” Nazareta said. “If we don’t get it the first time, the PAR will be denied and we will have to appeal it.” By avoiding that, Nazareta keeps providers’ time free for patient care and ensures that patients’ medications regimens are not interrupted.
In addition, Nazareta looks for the most affordable co-pay and financial assistance for patients who need it to pay for their medications. Sometimes an insurance plan requires a preferred drug (generic or brand name) or that it be picked up at a preferred pharmacy. Nazareta handles these and other details to head off delays. She doesn’t make clinical decisions on medications, but gives providers the information they need to do so. And whenever possible, the MARC has the hospital’s pharmacies fill the prescription, another time saver and convenience for patients.
The MARC has helped to ensure patient safety and maintain the quality of care, Pearson said. For example, patients prescribed methotrexate, a rheumatoid arthritis medication, must have had a liver enzyme test within the past three months, as the drug can cause the enzymes to rise to toxic levels. That’s the kind of detail Nazareta keeps an eye on so the approval boxes get checked.
“The process for approving high-cost drugs for the treatment of rheumatoid arthritis and other drugs is frequently very labor-intensive and labyrinthine,” Pearson said. “People in the MARC understand these medications and how to interface with insurers. They level the playing field.”
The MARC, which launched the CRC in 2013 and services for PARs in 2014, plans to expand to more clinics in fiscal year 2017, which begins July 1, said MARC Project Manager Anita Shen. She said it will be important to help new clinics that come on board fit the MARC into their workflows.
“We’re proud of the benefits we’ve been able to provide clinics and providers,” Shen said. “We’ve experienced a lot of growth and want to make sure that our services are embraced for the clinics that choose to adopt the MARC.”
Pearson, for one, sees the MARC as an important part of the hospital’s development and adaptation to the future. He credited Associate Director of Ambulatory Services Andrew Davis, PharmD, for “a great buildout” of a concept that Pearson believes should grow.
“We are at a place where the system is engaged in colossal growth,” he said. “The capacity of our clinics to be responsive to that is a challenge, and a centralized system like the MARC helps both the clinics and the patients we serve.”
Contact the MARC Monday through Friday, 8 a.m. to 4:30 p.m., at 303-752-5148 Ext. 25148. For information on prior authorizations, call 1-844-366-MARC (6272) or email [email protected].