A web-based approach to preauthorization for insurance

Most specialty medicine needs preauthorization for insurance coverage and it's a headache for providers and staff. ZappRX hopes to solve the problem with a web-based app.

Preauthorizations for insurance are akin to a four-letter word for providers. A March 2018 study by the American...

Medical Association showed 84% of physicians found the burden of having to get insurance prior approvals either high or extremely high, and 86% said the problem is just getting worse.

Enter startup ZappRx with a portable web-based app it hopes will eliminate the tedious back and forth with insurance companies and streamline physician communication and patient consent. Armed with six years of research and product development, as well as $41 million in just-raised B-level funding, ZappRx hopes to tackle this relatively obscure -- and often overlooked by mainstream health IT efforts -- problem on a broad scale.

And there's no question it is a problem. Today's aging population requires more access than ever to specialty medications for conditions ranging from chronic obstructive pulmonary disease (COPD) to cancer, and the vast majority of those drugs require preauthorization for insurance payment due to their high cost. In most practices, prior authorizations are done by staff, by hand, and transmitted via fax machine.

"The way they tracked preauthorizations before involved sticky notes and whiteboards and Excel spreadsheets," said Libby Webb, senior vice president of product at ZappRx. "There was nothing that existed that kept that information in a centralized location." The process was labor intensive, but also off-putting to patients. The AMA study showed 78% of doctors believed the delays inherent in preauthorization for insurance could lead to patients abandoning the treatment altogether.

With the ZappRx platform, the provider's team can use an iPhone or iPad or tablet to fill out forms for preauthorization for insurance, capture patient consent and send the information to the insurance company. A central dashboard allows staff to see at a glance exactly where each request stands and provides access to any needed follow-up requests. For states allowing electronic physician signatures, that feature is built in. "The app saves all the data and it's essentially 'one and done' for each patient," Webb said.

"From the moment a patient is diagnosed and drugs are selected we process that entire journey through our web-based app today," Webb said. "Otherwise it is a paper-based process with staff literally filling out forms by hand and faxing them to the payer for prior authorization. There is no way to know what's happening with the payer or when forms are sent to the specialty pharmacy. It's a black hole."

The black hole is why ZappRx was founded in 2012, Webb said. The CEO had a family member who, while waiting on preauthorization for insurance of a specialty medication, grew dramatically more ill. So the idea for ZappRx was born with the hope that medications could get into the hands of the patients more quickly than before.

But providers and payers may also benefit from the streamlined process. Insurance companies devote a lot of staff to handling incoming faxes and they also have to spend time deciphering handwritten and often blurry paperwork, Webb said. Instead payers can print the ZappRx form and move forward. Provider practices may find this also eases the administrative burden for them, Webb said, which can translate to less staff turnover. "People don't go into medicine to do paperwork."

To date the ZappRx solution is at work in over 30 practices and large academic medical facilities. Now the platform is focused on three pulmonology diseases, and is in beta for gastroenterology, and with plans to move into rheumatology and orphan diseases/cancer in the near future, Webb said.

And, while ZappRx does not currently integrate preauthorization for insurance with any EHRs, Webb said the company is ready to work with customers on a plug and play API-based integration layer to make that vision a reality.

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