The vital role of the pharmacist — stepping up service

Good pharmacists are a crucial source of information for members. They:

  • Talk to members about how to take their medicines
  • Alert members to possible side effects, and
  • Look out for potential harmful drug interactions or drug allergies.

But pharmacists can get bogged down in lengthy processing and paperwork. In fact, pharmacists say they spend an average of five hours each week on prior authorizations (PA),1 which can take time away from customer care. And all that time spent on paperwork equals money — in excess of 31 billion dollars each year.1 The more tools pharmacists have to speed up processing, the more valuable they are to your members.

Overcoming the challenges: faster prior authorization

A big frustration for pharmacists comes from the time-intensive process to get approval on drugs requiring prior authorization (PA). The traditional method — filling out paper forms, sending faxes and following-up by phone — takes time away from member care.

Blue Cross and Prime offer electronic prior authorization (ePA) service through CoverMyMeds.® This speeds up the PA process and allows pharmacists to quickly close the loop with doctors. Using this online tool means less work for pharmacists, fewer callbacks and reduced administrative costs.

In fact, a Prime study of more than 4,000 electronic prior authorizations found Prime’s automated system reduced PA turn-around time by as much as 90 percent.2

PA volume is increasing by more than 20 percent per year.1 In 2014, 71 percent of PA requests were initiated at the pharmacy.1 This makes ePA an important time-saving tool to help members get the medicine they need.

See more about ePA.

In the loop, not out of touch

Health care is an ever-changing industry and pharmacists need to be up to date on claims processing, benefit offerings and legislation. To help, Prime offers the following services:

  • A quarterly Prime Perspective newsletter with plan-specific formulary and benefit updates. 
  • An online pharmacy provider manual containing processing details and links to dozens of helpful web pages.
  • 24-hour pharmacy contact center staff ready to answer questions about medicines, prescriptions, point-of-sale messaging, benefits and formularies.
  • An informative fax series offering reminders and advice.
  • A consultative audit process in which Prime staff regularly reviews claims to help pharmacies maintain best practices.
  • A website for pharmacists to access audit-related information and insights. 

When members rely on medicines to get or stay healthy, they also rely on their pharmacists for help. To develop trusted relationships, pharmacists need to spend more time with members and less time on paperwork. With these vital services, they have the tools they need to help members feel better and live well.

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1. CoverMyMeds. (2015). ePA national adoption scorecard. Retrieved from author website: https://epascorecard.covermymeds.com

2. Prime study 2013.

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