The UNC Hospitals Department of Pharmacy won an award for reducing patients' financial risk through drug pre-certification.
The hospital won the 2019 Innovator Award at the National Oncology Conference, hosted by the Association of Community Cancer Centers and held from Oct. 30 to Nov. 1.
Insurance companies have complex policies regarding what services and medications they will and will not cover, Suzanne Francart, assistant director of pharmacy for the Medication Assistance Program and Pharmacy Revenue Integrity team, said. If the hospital administers a drug or service but an insurance company refuses to cover it, the hospital and its patients face a significant financial burden.
“What we have done at UNC, and what we submitted and won the ACCC Innovator of the Year Award for, is building a pharmacy department-run, closed loop model to ensure that pre-certification is done prior to receiving high-dollar outpatient drugs,” Francart said.
Francart said they began implementing the model about six years ago, when high-dollar claims were increasingly denied by insurance companies. Many patients, including those receiving expensive chemotherapy, questioned why their services were not covered.