PracticalDermatology

After the lull of the holidays and a break from the office, New Year’s resolutions and the reset of our personal life are common… but what about the office reset? For those of us who are in the role of Biologic Coordinator, we find ourselves returning to the office with the need to re-organize and re-prioritize the needs of the biologic patient. The new year brings many challenges for the biologic coordinator, some of which may be re-authorizations, navigating step edits, and dealing with changes of insurance requiring a new enrollment for the biologic patient. This increased load of specialty medication enrollment and prior authorizations and can lead to an overwhelming experience, including burnout for the biologic coordinator. Let’s review some best practices that may make the difference heading into 2023.

Avoiding Burnout

It’s a good time to reevaluate your resources, review formulary changes, and create a systematic routine to tackle enrollments. During this time it may seem like things are piling up around you and it might feel a little suffocating, so you need to be sure to work within your means. Biologic coordinators tend to wear a lot of hats. Inherently, the more hats you wear, they more likely you are to spread yourself too thin, which may lead to burnout. Let’s try to pace ourselves and learn from some mishaps or mistakes in 2022.

The Three Rs

Considering best practices to start of the New Year, we should consider a few important things. Let’s discuss the three Rs: Response, Resources, and the “Recipe”.

Response. For starters, let’s look at a proactive Response. Organization is key. If your brain is cluttered, it’s difficult to work efficiently. You cannot effectively respond as a biologic coordinator in the clinic if you’re not prepared. Try to block out some time to re-organize your list of biologic patients, their specific needs, and how immediate those needs may be. Create or modify your system so you can best respond to your patients’ cases. Be sure you have access to the documentations, carve out time to work cases, and make sure you read those letters for the payers regarding reasons for denial ect. Lastly, be sure to respond promptly…some payers will only allow a short window of opportunity to submit supplemental documentation before they will deny the Prior Authorization.

Resources. Next, let’s look at our Resources. You have many resources available during specialty drug enrollment. Biologic coordinators tend to work on their own island at times and are very independent. Do not forget the resources that you have at your disposal including your medical sales professionals, field reimbursement managers, other office staff who may be able to lighten the load and lend a helping hand. Additional resources available to help in the process are the American Academy of Dermatology (AAD), electronic enrollments (eE), or electronic prior authorizations (ePA). There are many tools to help you be more efficient once you have your specific workflow. Lastly, if you ever feel stuck don’t forget to reach out to the Biologic Coordinators of Dermatology (BCOD) forum, where you have a pool of members who do what you do on a daily basis and may be of assistance, help with a template, and streamline your workflow.

Moral to the story: don’t try to take on the world, ask for help and work within your means. When there is a stack of enrollments to do, some best practices would be to triage the enrollments. Remember, triage is a term used when resources are stretched thin and you need to do the most good for the most amount of people. Triage means to “sort”. Usually, we sort in chronological order or first-come first-serve in regard to patient enrollments, but don’t be afraid to triage or sort the needs of your patients in order to prevent yourself from being overwhelmed trying to get to the patient who really needs their medication versus the one who just received a 90-day supply before their insurance changed. Take into account how many syringes they have left, when they anticipate their insurance will change, and most importantly, their quality of life. Those patients who are uncomfortable go right to the top of my hot list and get prioritized.

Recipe. Lastly, knowing the Recipe to your target specialty medication or biologic therapy will be a deciding factor on your quick approval process. Being knowledgeable of the biologic or specialty medication formulary and being confident enough to inform the prescriber of what is required for this medication to get approved is very important. In addition, when it comes to step therapy like phototherapy, methotrexate, cyclosporine, or if another biologic is preferred and the prescriber is not going to prescribe that, make sure to submit proper rationale to expedite the approval process. Biologic Coordinators should be confident to collaborate with the prescriber and assist in the process.

Finding Solutions

Biologic coordinators have become important industry specialists, visible patient advocates, and recognized as valuable problem solvers.

“A Medical Assistant sees the problem: a Biologic Coordinator sees THROUGH the problem to get the solution.” – Neal Bhatia, MD.

We have a unique skill set and are great at doing what we do best… however, we need a process, and the beginning of the year is the best time to reevaluate and revisit that process.