Simplifying Access: Prior Authorization Part 2

In Episode 2 of our Simplified Access Series, we continue our deep dive into practical strategies to streamline the prior authorization (PA) process and reduce delays in patient care. Nurse practitioners Tedra Gray and Allison Moser return alongside Jeff Dunn, PharmD, a veteran in managed care and president of a transparent PBM, to explore real-world solutions for improving first-attempt PA success.

This episode focuses on the proactive steps clinicians can take to avoid common PA denials, including accurate documentation, ICD coding, benefit verification, use of electronic prior authorization tools, and collaboration with pharmacy liaisons. We also unpack how templates, test claims, and payer-specific nuances can strengthen submissions.

Jeff offers valuable insights from the payer perspective, detailing the most common reasons for PA denials—such as missing clinical information or lack of step therapy documentation—and how providers can better align their approach with evidence-based policies. The conversation wraps with actionable ideas on how APPs and payers can build trust, improve communication, and leverage technology and AI to reduce administrative burden and deliver faster access to care.

If you're a GI or hepatology clinician, pharmacist, or APP navigating the complexities of the medication approval process, this episode is packed with expert guidance and proven strategies to elevate your access workflow.

Don’t forget to watch Part 1 on our GHAPP digital hub, and stay tuned for Part 3 of this essential series on simplifying access.