Arrive Health’s prior-authorization system, codeveloped with UCHealth, to roll out systemwide.
Arrive Health has been helping providers and patients find the right medications at the best-possible prices for years. Now it’s drastically speeding up the prior-authorization process to get drugs that require an insurer’s approval into patients’ hands faster and more efficiently.
A recent American Medical Association survey of 1,000 physicians found that care delays or abandonment related to prior authorization was “wreaking havoc” on patient outcomes, with 94% saying it delayed care. Roughly one quarter of those surveyed reported it sometimes led to patient hospitalization; 13% said it had led to life-threatening events or interventions to prevent impairment or damage; and 7% said it had led to patient disability, birth defect, or death.
The prior-authorization system is working smoothly at three UCHealth clinics with the goal of rolling it out systemwide by the end of 2025, says Surabhi Palkimas, PharmD, UCHealth’s pharmacy operation manager and a professor at the Skaggs School of Pharmacy and Pharmaceutical Sciences.
Arrive Health has been a UCHealth CARE Innovation Center partner since 2016. UCHealth invested in the Denver-based health-IT firm and helped it develop a clinical decision support application that integrates with the widely used Epic electronic health record. (That’s the engine behind UCHealth’s My Health Connection patient portal and much more.)
The comparison-shopping tool has helped providers tailor medications to UCHealth patient needs, budget, and insurance coverage since 2019, and it’s now used by more than 300,000 providers and their patients nationwide, says Christie Callahan, Arrive Health’s chief operating officer.
More recently, Arrive Health worked with UCHealth to add an ability to cut the time it takes patients to get approval for a drug requiring prior authorization from three to five days to less than three days – and, often, within a single day, Palkimas says. That’s relevant for a lot of patients. Among the pharmaceuticals frequently subject to insurer approval before prescriptions can be filled include GLP-1 receptor agonists such as Wegovy and Ozempic, albuterol asthma inhalers, lidocaine patches, and ADHD medications, she says.
A better way to do prior authorizations
Prior authorization has typically involved handoffs between physicians and other providers who prescribe medications, pharmacists, and pharmacy benefit managers such as CVS Caremark who work with health insurance plans to develop and administer pharmacy benefits. The handoffs took time, and they happened between different systems. The physician might not have known that a drug needed prior authorization in certain cases, which the patient might find out at a neighborhood CVS or Walgreens where the pharmacist would be unable to fill it. That meant frustration for patients and calls to providers to figure out what the holdup was.
Now the prescribing provider can see in Arrive Health’s Epic tool whether a drug requires prior authorization, and the patient also knows that right away. The prescription immediately lands in the UCHealth Pharmacy Authorization Center (PAC) queue via Epic. The pharmacy team can address the questions insurers need answered to authorize the prescription and send documentation to the right insurer, Palkimas says.
“That all happens same day of receiving the request, and then the insurance company can get back to us, sometimes the same day, sometimes the very next day, so it cuts down the whole prior-authorization process,” she said.
Speed hasn’t been the only advantage of the Arrive Health prior-authorization system, says Whitney Vuchetich, a nurse practitioner and director of UCHealth Internal Medicine – Lowry in Denver. Her clinic, along with UCHealth Primary Care – Briargate and UCHealth Family Medicine – Boulder, are live on the system. Vuchetich estimates that perhaps 15% of the prescriptions she writes channel into prior authorization. The system has helped keep patients apprised of prescription status, among other benefits.
“The most important thing as far as how it’s impacted my day-to-day workflow is actually being able to have a conversation with the patient,” she said. “Prior to this, we didn’t often know what was going to happen after we entered the order and it left our screen.”
Patients know prescriptions are headed for prior authorization before appointments wrap up, and Epic adds a note to the after-visit summary reminding them as much, too.
“Really, from the provider standpoint, this really has not had downsides for us,” Vuchetich said. “It’s been a really positive experience.”
