Recent headlines and industry surveys highlight a growing concern: navigating prior authorization is a significant challenge for patients, prescribers alike. Delays, administrative hurdles, and varying standards across health plans can complicate access to needed treatments. These headlines have sparked renewed scrutiny of a process that’s too often misunderstood and has prompted action at the highest levels — from federal agencies introducing new rules for faster, more transparent decisions, to congressional hearings calling for greater accountability.
At Benecard, we believe prior authorizations, which we refer to as “clinical reviews”, deserve a clear and balanced conversation. Yes, the system needs improvement. But clinical reviews also play a vital role. They help protect patients’ health and safety, ensuring they receive the most appropriate, safe, and effective care. They also ensure our employer plan sponsors pay for only those covered medications being used in accordance with FDA approved uses and/or supporting medical compendia.
WHY CLINICAL REVIEWS EXIST
There are over 20,000 prescription drugs on the market today, each with evolving FDA-approved uses, off-label applications, changing safety warnings, and potential interaction risks. This makes it impossible for prescribers to track every detail for every patient, especially when a patient sees multiple prescribers or has a complex treatment plan.
Clinical reviews address this gap by consolidating prescription information into a single system, enabling PBMs to identify and report key risks such as harmful drug interactions, duplicate therapies, and new safety concerns that may not be visible to a prescriber. This is not about questioning a prescriber’s expertise. It’s about supporting them with additional safeguards to ensure the clinical appropriateness, safety, and effectiveness of medications before they are approved and dispensed to the patient. Want to see a real-world example of how this works? Click the link below to read our case study which demonstrates why clinical reviews are essential for patient safety.
BENECARD’S COMMITMENT TO BETTER CARE & LESS RED TAPE
At Benecard, clinical reviews aren’t just an administrative checkbox; they are a critical safety net to make sure each patient receives the right drug, in the right dosage and quantity, at the right time.
Our patient-first philosophy focuses on protecting members and plan sponsors by ensuring safe and appropriate use of prescription medications. While cost savings often follow from these safeguards, clinical oversight of the patient’s safety is always our top priority.
One of the biggest frustrations we hear from members with prior authorizations is the waiting — not knowing where things stand, when a decision will be made or having to go through the process for the same drugs on a routine basis. We have invested heavily in technology and service enhancements to reduce friction, improve communication, speed up decisions and extend the approval duration:
- Electronic Prior Authorizations (ePA) through CoverMyMeds for faster, more accurate submissions and reduced back-and-forth paperwork with the prescribers.
- Real-time status tracking via our Member Web Portal so members have detailed insight into the status of their clinical review.
- 24/7 Member Services for questions, support, emergency and expedited requests.
- Extended approval durations of clinical reviews, with approvals lasting from 1 to 3 years depending on the therapies and clinical appropriateness.
- Care Coordination Program offered through optional enrollment to members we identify with multiple medications across different therapeutic classes. This program delivers personalized guidance through the prior authorization process and education about their coverage options.
Sources:
Americans say prior authorizations are a major problem, insurers vow to reduce burden
