A Game-Changer for Pharmacy Teams

Prior authorization (PA) is a critical yet time-consuming process that pharmacy teams face daily. It often leads to prescription delays, increased administrative workload, and patient frustration. However, with the rise of prior authorization automation, pharmacy teams can streamline their workflows, reduce processing times, and enhance patient care. In this blog, we’ll explore the challenges of manual PA, opportunities for automation, and why pharmacy teams should embrace this technology in 2025.

The Challenges of Manual Prior Authorization

Pharmacies and healthcare providers alike struggle with the inefficiencies of manual prior authorization, including:

• Time-Consuming Processes: Traditional PA approvals can take hours or even days, delaying patient access to essential medications.

• Increased Administrative Burden: Pharmacists and staff spend valuable time on phone calls, faxing documents, and following up with payers, provider clinics, and patients instead of focusing on patient care.

• Prescription Abandonment: Lengthy PA delays often result in patients leaving prescriptions unfilled, impacting health outcomes.

• Regulatory and Compliance Issues: Pharmacy teams must navigate complex payer requirements, increasing the risk of errors and denials. Additionally, staff may be unfamiliar with specific requirements and clinical terminology, leading to miscommunications and further delays in the approval process.

How Prior Authorization Automation Works

Prior authorization automation offers several opportunities to streamline the process and reduce administrative burden:

• Checking the formulary ahead of time: Automated formulary tools can verify medication coverage before prescriptions are submitted.

• Calling PBMs for benefits verification: Automated systems can retrieve coverage details, request PA forms, and even initiate PA over the phone.

• Downloading forms from payer websites: Automated workflows can access and populate the correct PA forms, reducing manual searches.

• Automated submission and tracking: PA requests can be submitted electronically, with AI monitoring and following up at the right cadence as needed.

• Calling provider clinics: Automation can request necessary clinical documents, such as progress notes, without staff intervention.

• Notifying patients of approvals and copay amounts: AI-powered systems can contact patients, keeping them informed and reducing pharmacy callbacks.

• Handling denials and alternative options: Automated calls or messages can notify patients about PA denials and present options like appeals or alternative treatments.

Key Benefits of Automating Prior Authorization

Pharmacy teams that implement PA automation experience several key advantages:

• Faster Approvals: AI-powered automation can reduce PA turnaround time from days to mere hours, improving patient access to medications.

• Lower Workload for Pharmacy Staff: Automation minimizes administrative tasks, allowing pharmacists to focus on patient care.

• Fewer Prescription Abandonments: With quicker approvals, patients are more likely to adhere to their prescribed treatment plans.

• Regulatory Compliance: AI-driven automation ensures adherence to payer requirements and reduces the risk of errors.

What to Look for in a Prior Authorization Automation Solution

When choosing a PA automation solution, pharmacy teams should consider:

• Seamless Integration: Compatibility with existing pharmacy and EHR systems.

• Automated Workflows: Handles multiple steps of the PA process, including documentation management, payer interactions, and coordination with provider clinics and patients.

• High-Throughput Solution: Expedites approvals and processes a large volume of PA requests simultaneously.

• User-Friendly Interface & Support: Ensures easy adoption and troubleshooting.

The Future of Prior Authorization Automation

The future of pharmacy operations lies in AI-driven automation. With increasing healthcare adoption of automation and ongoing advancements in AI, we are moving toward fully automated prior authorizations, eliminating manual intervention altogether.

Optimize Your Prior Authorization Process Today

Prior authorization automation is transforming pharmacy workflows by reducing processing times, minimizing administrative burdens, and improving patient care. Now is the time for pharmacy teams to explore AI-powered automation solutions to stay ahead in 2025.

Ready to optimize your pharmacy’s prior authorization process with AI-powered phone call automation? Pharmesol is an AI assistant developed specifically for pharmacy teams that automates phone calls, messages, and documentation and brings reliable and consistent capacity 24/7.

Schedule a demo with Pharmesol today!