PBD’s account management and client support teams got to work immediately once they were made aware of the issue. When the member was having issues receiving PA approval for her medication, one of our client support representatives faxed an urgent PA request to the member’s doctor. When the PA was not received, our representative was not content with simply allowing this PA to be forgotten. The next course of action was to receive approval from PBD’s Prior Authorization team to extend the previous PA request that was on file. Once completed, our client support representative contacted the member’s pharmacy directly and helped them put the claim through successfully on behalf of the member.
After going through the appropriate steps for the member, our customer support representative contacted the member’s physician once again to confirm the prior authorization was successfully completed. However, this was not the end of the story.
That is when the member’s physician indicated they wanted the member to try a different medication prior to signing off on the requested PA. Not fazed by the quick and fluid nature of the chain of events, our representative called the member’s pharmacy to cancel the old prescription and deactivate the override on the previous PA that was extended as part of the initial resolution. The new medication was less expensive for the group, but still a Tier 4 $60 copay for the member.
In addition to the persistent and dedicated work of the client support representative, our account management team also stepped in to offer added value for both the plan sponsor and member by quickly identifying a generic equivalent of the new medication the physician requested the member use.
The generic drug, which was a Tier 1 product on our formulary, had the same drug efficacy, but cost less and did not require a prior authorization for the member to obtain.