Free tool generates prior auth appeal letters

Earlier this year, the Academy launched the Prior Authorization Letter Generator, a free, web-based tool that allows members to easily create appeal letters to help overturn denials for prior authorizations. Since its launch, Academy members have used the tool to generate more than 15,000 letters.

The Academy recently expanded the tool to include letters for nine dermatologic diseases. Member to Member discussed the creation of the tool with Mark, Lebwohl, MD, who helped lead its development.

Member to Member: Why did the Academy develop the Prior Authorization Letter Generator tool?

mark-lebwohl_newDr. Lebwohl: When we surveyed dermatologists about complaints they had about practice, at the top of the list was their inability to prescribe the medications they want for their patients. Neal Bhatia, who is on the AAD Board of Directors, eloquently stated it when he said, “What used to be called the prescription pad is now the suggestion pad.”

  PM_drug_screen.png
The tool allows users to generate letters for acne vulgaris, actinic keratoses, atopic dermatitis, hidradenitis suppurativa, primary focal hyperhidrosis, psoriasis vulgaris, rosacea, tinea unguium, and urticaria. Access the tool.

Nine out of 10 times when we write a prescription it gets denied at the pharmacy level. It’s denied because the pharmacy benefit manager doesn’t want the patient to get the drug, or the insurance company suddenly decides it’s not going to cover it. What they cover on Monday, they don’t cover on Tuesday. It changes from day to day. It wastes our time and prevents us from giving the medication we want to our patients.

Even worse, there are times when we know that a patient needs a particular medicine for a particular reason. Invariably, we are told they have to fail something else in order to get that particular medication, even when we know the steps they have to fail are not correct for them.

The Academy’s advocacy team, through the State Access to Innovative Medicines Coalition, wrote the language that ended up in many step therapy bills around the country.

Theoretically, in states with step therapy laws, insurers should not be able to deny medications. But that’s not the way it works. Step therapy laws don’t prevent insurance companies from suggesting steps.

But if the doctor challenges the steps in states with step therapy laws, it puts the insurance companies on the spot. If you send them a letter explaining your rationale for a particular prescription, it difficult for them to deny your patient that drug. This also can work in states where the laws don’t exist.

What’s happening is that insurance companies are telling us that instead of using Drug A, use Drug B. Dermatologists are using Drug B because they feel like they don’t have a choice. However, particularly in the states with step therapy laws but also in other states, we do have a choice. And sending a letter gets their attention.

No one went to medical school to write letters. So, we thought, how do we make sending prior authorization and step therapy protocol override determination letters easy for our members? We decided to create a web-based tool that allows AAD members to generate a pre-written letter that provides all of the reasons for patients to get a particular drug.

With this new tool, it takes less than a minute to generate a comprehensive letter describing why a particular drug should be given to a particular patient.

For every drug, we explain why that drug should be prescribed ahead of any other drug.

PA_toolkit_screen.png

M2M: Who created the Academy’s new Prior Authorization Letter Generator?

Dr. Lebwohl: When I was president of the Academy in 2014, I created the Drug Pricing and Transparency Taskforce. The taskforce worked with AAD staff to develop a multipronged approach to help patients get access to the medications they need.

Members of the taskforce wrote the letters that are included in the Prior Authorization Letter Generator. We asked experts in different areas to write letters for specific drugs. So, acne experts wrote the acne letters, for example, and I and my colleagues wrote many of the psoriasis, urticaria and eczema letters.

M2M: How does the tool work?

Dr. Lebwohl: Currently the tool allows users to generate letters for the following diseases:

  • Acne vulgaris
  • Actinic keratoses
  • Atopic dermatitis
  • Hidradenitis suppurativa
  • Primary focal hyperhidrosis
  • Psoriasis vulgaris
  • Rosacea
  • Tinea unguium
  • Urticaria

Once you select a disease, you’re quickly taken through a series of questions. You select a drug and enter insurer information. Then the tool generates a letter prepopulated with rationale to support your drug choice, your contact information, and the insurer’s information. You can easily paste the letter onto your letterhead.

For each disease, we created a list of steps that an insurer might take you through to get approval. For a psoriasis drug, for example, the insurer might say that the patient has to fail phototherapy first. So the letter includes a paragraph that says phototherapy is three times a week therapy, and it’s difficult for patients to hold a job and get treatment three times a week.

Insurers often ask us to fail methotrexate. Well, methotrexate has a long list of contraindications, and they’re all listed in the letter.

For every drug, we explain why that drug should be prescribed ahead of any other drug. For example, if the insurer told me to use Humira and I wanted to use Enbrel, we have a paragraph in the letter that explains why Enbrel is the drug to use and Humira is not. And if the doctor prefers Humira to Enbrel, we have a paragraph explaining that choice.

When we see a patient, a lot of individual characteristics of the patient go into our calculation of which drug is best for that patient. It isn’t just a cookbook that someone at an insurance company can put together for us and say we have to use a certain drug.

Here’s a perfect example: If a patient has psoriasis and a history of skin cancers, the insurer will often ask that the patient fail a TNF blocker. Well, TNF blockers increase skin cancer risk so that wouldn’t make any sense. So, we included that rationale in the letter.

M2M: Do you expect this tool will save members a considerable amount of time and paperwork?

Dr. Lebwohl: Absolutely! I can’t tell you how often I used to come to my office and find a pile of charts with requests for letters to send insurers. That doesn’t happen to me anymore because my nurse knows we can go to the AAD website, and the letter will be written for us. Since the tool has been launched, I haven’t had any charts waiting for me.

We’ve made it so easy. The letters contain everything you need to get access to the drugs your patients need.

ACCESS THE TOOL