A: Sufficient provider treatment and patient adherence to the prescribed glaucoma treatment enhances our ability to best manage glaucoma. As access to insurance panels, newer glaucoma drugs and related prior authorizations all play a role here, providing “how-to” answers to these items is paramount. Here, I break up these questions:

Q: How can I get on insurance panels?

A: Credentialling includes following these steps:

1. Obtain a National Provider Identification (NPI) number at nppes.cms.hhs.gov/#/ .
2. Obtain malpractice insurance, which is sufficient and/or exceeds the requirements for the desired insurance company.
3. Obtain/complete a CAQH application at proview.caqh.org/PR/Registration for a more streamlined and standardized process.
4. Register as a participating or nonparticipating provider for Medicare at ngsmedicare.com .

Once the above steps are complete, contact/register with the specific insurance companies for whom you want to become a provider, and stay on top of the registration by following up regularly, as it may take some persistence to get approval. Also, because you have a limited amount of time to respond to any insurance inquiries, be sure to update your email communications from each insurance plan so they go directly to your active inbox.

Q: How can I help my patients access newer glaucoma drugs?

A: The insurance company’s preferred medications may need to be trialed first to increase the likelihood of coverage of other desired or newer medications. So, if you try to prescribe a new drug and the prior authorization requirements are not met, you may need to go back to the old drug before receiving sufficient approval.

Q: How can a practice streamline prior authorizations for glaucoma drugs?

A: With any trialed, preferred medications, it is important to create a personalized paper trail that documents adverse effects from these specific drugs and/or insufficient response to treatment. As a provider, keeping track of the tolerability and efficacy of trialed drugs in a virtual glaucoma flow chart or EHR allergy list can help with this endeavor. Sharing this information with the insurance companies through the “prior authorization” process will help the patient to be more likely to receive coverage for the desired medications. Additionally, most (if not all) of the companies have some form or coupons, rebates and/or patient assistance programs readily available to help patients. Finally, in some situations, a provider phone call to the insurance or drug companies helps add context and urgency to the request for coverage.

KEEP TRYING!

Treating glaucoma is both a science and an art, mixed with patience and persistence. OM

DR. LIFFERTH practices at Grossnickle Eye Center as a consultative optometrist with an emphasis in glaucoma management, and he is a member of the Optometric Glaucoma Society. For additional glaucoma cases, you can also follow Dr. Lifferth on his Instagram account: glaucomaqd. Disclosures: None. Email him at austinlifferth@yahoo.com.