The CEO of the internationally recognized pharmaceutical, biotechnology, and life sciences council, Accreditation Council for Medical Affairs (ACMA), shares his motivation to launch the Prior Authorization Certified Specialist Program.
The Accreditation Council for Medical Affairs (ACMA), an association whose mission is to elevate industry-standards in Medical Affairs, has launched its new accredited professional certification, the Prior Authorization Certified Specialist (PACS).
Established in 2015, the ACMA is a global organization zeroed in on raising the bar for the pharmaceutical, biotech, medical, and diagnostics industries. The organization provides a full suite of solutions for the life sciences industry, including enterprise solutions around predictive analytics and a Medical Affairs CRM platform. The new Prior Authorization Certification Specialist (PACS) program adds to the ACMA’s other certification & training programs, such as the Board Certified Medical Affairs Specialist (BCMAS).
The Prevailing Issue of Prior Authorization
Prior authorization is a health plan cost-control measure that confines access to medicinal drugs, medications, and services by expecting doctors to obtain approval from managed care payers before delivering the recommended treatment or requested service. The Prior Authorization (PA) process comes between doctors and their patients’ care, which explains why there is a need to teach healthcare professionals how to navigate the process.
Albeit an extensive cycle, a definitive motivation behind PA is to enhance patients’ understanding of the outcomes by guaranteeing that they get the most suitable medicine while lessening waste, mistakes, and pointless physician-endorsed drug use and cost. PA is tied to maintaining medical services’ costs within proper limits. With medical providers having more control over which treatments they will charge for, they can give costlier medicines to individual patients who need it most.
Soliman underscores the degree to which a significant number of patients are uninformed of the prior authorization process. Insurance coverage for some medications, tests, and referrals is hard to obtain because insurance companies make the process difficult for the doctors and their staff. “There’s very little we can do,” Soliman said. “This is directed by the insurance providers.”
Specifically, in the wake of the COVID-19 pandemic that has immobilized the world, prior authorizations are getting progressively significant. While some insurance plans have made measures simpler with brief PA overrides or waived prerequisites, they frequently are restricted to COVID-19-related administrations. “Therefore, there remains a need for the healthcare experts to learn how the prior authorization process works,” said Soliman.
Whenever a prior authorization is required, it’s important for doctors to teach patients about the cycle and the likelihood that the authorization will be denied. Doctors need to adequately discuss prior authorizations with patients to address the issue proactively as opposed to standing by until treatment has been denied.
According to a December 2019 study published in the Journal of the American Academy of Dermatology, the current prior authorization process can adversely affect patients due to delayed care, further putting their lives at stake. “The doctors need to comprehend, in advance, that prior authorization requires significant time and it could mean a delay in care, which adds to the healthcare professional’s responsibility,” said Soliman.
For field reimbursement specialists working in the pharmaceutical industry, prior authorizations can create an obstacle to market access for their products. Indeed, many field reimbursement teams in top 50 pharma are getting certified as prior auth specialists to better understand the challenges their customers face.
ACMA’s Prior Authorization Certified Specialist Program Bridges the Gap
Soliman emphasized that the prior authorizations remain a critical issue in medicine that is currently limiting the patient’s capacity to access healthcare. “We want to eliminate the barrier that patients face by providing training activities for healthcare providers,” he said.
The Prior Authorization Certified Specialist (PACS) program gives a thorough view of prior authorizations, how they came to be, and their purpose in modern healthcare settings. The certification is based on 12 self-guided modules and real-world models created by pioneers in the healthcare sectors. With this, learners can strengthen their information on both drug administration and service prior authorizations.
“We are eager to certify all working medical care experts who need to improve their insight and skills surrounding prior authorizations,”said Soliman. “Becoming a Prior Authorization Certified Specialist can absolutely make you a leader in healthcare,” he added.