Prior Authorization for Rare Pulmonary Diseases: Lessons from Real-World Approvals

Challenges

• PA delays for costly treatments like Treprostinil & Pirfenidone.
• 70% initial denial rate (AMA, 2023).
• Case: 52-year-old IPF patient faced 4-week delay due to:
  • Insufficient documentation.
  • Step therapy requirements.
  • Coding errors.

Solutions

• Stronger Justification – Detailed letter with clinical data.
• Accurate Coding – Correct ICD-10 (J84.112) & CPT codes.
• Doctor-to-Insurer Talk – Secured approval in 2 days.
• Electronic PA (ePA) – Cut approval time by 35%.

Results

• PA approved in 1 week (vs. 4-6 weeks).
• 40% less admin work for providers.
• 25% increase in PA approvals.

Key Takeaways

• Better Documentation & Coding prevent denials.
• Direct Talks speed up approvals.
• Automation reduces delays.

Practolytics Can Help

• Faster PA approvals.
• Accurate coding & expert documentation.
• Less admin work, more patient care.

Visit Practolytics.com for hassle-free PA!