Lost between the payer and the pharmacy, with Dean Erhardt of D2 Solutions

Prior authorization submissions often come back denied with no reason given, and Dean Erhardt says the vast majority of rejections are administrative in nature. Something as small as a ZIP code that doesn't match the city on the form can get a request thrown out.

Medical Economics Senior Editor Richard Payerchin sat down with Erhardt, president and CEO of D2 Solutions, a health care consulting and technology company that works with drug manufacturers, pharmacies and payers on market access and patient support.

Erhardt explains how submitting to each payer's exact requirements for a given product can shorten delays that he says stretch as long as three to four weeks for some products. He also covers why staff turnover is a hidden cost when a practice weighs labor against technology and why training on a new platform shouldn't take more than a 15-minute call. He describes how reaching a patient about a pending approval can take as many as nine phone calls, and he says a couple of artificial intelligence (AI) classes a year can keep a practice's staff from falling behind.

Don't miss our recent episodes on value-based care, prescription abandonment, same-day Medicare payment cuts and moral injury in medicine.

Music Credits:

Her Name by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:40 | Cold open Erhardt on what a newly diagnosed patient hears from everyone involved in getting a medication approved.

0:40 – 1:44 | Introduction Austin Littrell introduces the episode and the guest.

1:44 – 3:47 | Meet Dean Erhardt Erhardt describes D2 Solutions' start in consulting in 2008 and his earlier career on the payer, distributor and pharmacy benefit manager (PBM) sides of the industry.

3:47 – 5:34 | Why prior authorizations stall Denials often come back with no reason given. Erhardt says delays of days are an infrastructure problem, and some manufacturers see products held up for as long as three to four weeks.

5:34 – 7:38 | Catching errors before they're submitted Payer call center guidance varies from one call to the next. Erhardt explains how matching each payer's requirements for a given product and flagging errors as small as a mismatched ZIP code prevent rejections.

7:38 – 10:16 | What patients go through Erhardt describes patients fielding conflicting calls from the physician's office, the pharmacy and the payer, practices needing as many as nine calls to reach them and patients who never learn about copay and affordability programs.

10:16 – 12:08 | Options for smaller practices Erhardt weighs labor against technology costs, points to staff turnover as a hidden expense and says training on a new platform should take about 15 minutes.

12:08 – 13:01 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

13:01 – 16:08 | Can technology offset the workforce shortage? Erhardt expects dramatic shortages by 2030 and says people nearing retirement now are more comfortable with technology than the generation before them. He points to digital therapeutics and wearables as part of care delivery.

16:08 – 18:03 | Upskilling staff around AI Erhardt's horse-and-buggy case for training, and why a couple of classes a year can keep a practice's skills from falling behind the technology.

18:03 – 20:56 | What comes after AI scribes Virtual consults that put a distant physician in a rural exam room, AI call centers and why Erhardt thinks patients are 12 to 24 months from being comfortable with AI agents.

20:56 – 22:40 | A volatile year for drug access Erhardt points to PBM reform, revamped manufacturer contracts, growing lists of non-covered drugs and the risk of a race to the bottom on biosimilar prices.

22:40 – 24:26 | Behind the "ask your doctor" ads Erhardt describes enrolling patients in manufacturer programs straight from TV ads and screening them before they reach a physician. He estimates about 30% of patients don't have a primary care physician.

24:26 – 25:54 | Direct-to-patient models and primary care Erhardt says patients will drive the shift toward virtual care based on convenience, and that they'll decide how they want to receive care.

25:54 – 27:46 | Investing in primary care Health care deserts, physicians 75 miles away and the case for setting aside telehealth time for patients who can't take hours off work.

27:46 – 28:54 | What the survey says about access Erhardt on the patient who learns they have a disease that costs $250,000 a year to treat and doesn't know what to do next.

28:54 – End | Closing thoughts and outro Payerchin thanks Erhardt, and Littrell wraps the episode.