Prime’s SmartRenew eases annual PA re-approval
March 1, 2023
Prime knows the Prior Authorization process can be a headache for members and prescribers. Here’s one effort to help reduce annual reviews.
Many drugs are subject to annual utilization management restrictions. That means members and prescribers must repeatedly submit prior authorization (PA) requests when PAs expire. PA requests can be a burden for members and add expense to plans that pay for clinical reviews. Some of those requests are for maintenance medications that have a high likelihood of re-approval.
Recognizing an opportunity to ease this administrative burden for all involved, Prime’s clinical team came up with SmartRenew. This program simplifies the PA process by identifying members with a PA expiring and automatically renewing the authorization if conditions for SmartRenew are met. With SmartRenew, everyone wins.
Sounds great, but how does it work?
Health plan clients can specify which drugs are eligible for SmartRenew to best align their strategies. Then, the automated program reviews each authorization to confirm if it should be renewed, which also helps eliminate PA reviews. If the authorization is approved by SmartRenew, members are notified 60 days in advance to ensure continuity of care. There is no action needed from members, prescribers or pharmacies, making this a much better customer experience.
SmartRenew by the numbers
- Since its launch in 2020, SmartRenew has seen high client adoption. Enrollment rates among our member base:
- -Commercial – 86%
- -Medicaid – 74%
- -Medicare Part D – 96%
- -26% of all authorizations that are currently being used and require renewal are evaluated via SmartRenew. 15% receive approval through SmartRenew, avoiding the PA process altogether.
“Smart Renew is one very successful piece of our overall effort to improve the PAs experience for members, prescribers and health plans,” explained David Lassen, Prime’s Chief Clinical Officer. He continued, “We feel good about the progress SmartRenew has made for renewal reviews, and our clinical team continues to work to improve other areas of the PA experience.”
Don’t miss more wins in the PA space featured throughout the year in this digest.
If you have questions, please contact your Prime client engagement or clinical contact.