Open Forum

------------------------------
Tony Kostelnak RN, GERO-BC
Sr. Manager, Nursing Strategy
Oak Street Health (part of CVS Health)
------------------------------

Hi Tony,

We have our Pharmacy Techs in a central hub doing all of our PAs. I have also had great success with Medical Assistants learning this role and doing a centralized model with MA's leading the charge. I do think that to properly fill out a PA it helps to have some training of the medical field. There is a lot of chart-combing that can go into these PAs (I have done many especially for diabetes supplies and they can be a bear). Clinical knowledge paired with a solid training program and utilizing the tools that are out there like CoverMyMeds will help you be successful. We also implemented an electronic signature system through Adobe so that if a paper PA came through or a company had a specific form they required, we could wire the paperwork to the provider electronically so the person doing the PA's did not have to be in the same room as the provider who was signing. 

Happy to discuss further if you have questions! 

------------------------------
Torie Bonnet MSN RN NE-BC NPD-BC
Associate Director of Nursing
Piedmont Health
Raleigh NC

bonnett@piedmonthealth.org
------------------------------

Original Message:
Sent: 10-09-2025 07:42
From: Anthony Kostelnak
Subject: Medication Prior Authorizations

Good morning everyone,

Currently, our RNs are handling all medication PAs, and it's proving to be a significant drain on their clinical time. 

 

We're a large, multi-state organization (27 states) and have established central departments that manage various administrative functions. We're exploring two potential solutions for offloading this work:

• Non-Clinical Staff: Has anyone successfully transitioned medication PAs from RNs to non-clinical staff (e.g., medical assistants, pharmacy technicians, or dedicated PA specialists)? If so, what were the key challenges and necessary training/oversight required?
• Centralized Resource: Does anyone have experience moving this work to a centralized department or team that manages PAs for multiple clinics/states? What was the organizational structure and process flow that made this successful?

For those of you using Epic, how are the critical pieces of information - such as the PA status, the need for a PA, and the final approval/denial-communicated effectively and reliably between a central team and the ordering provider/clinical team within the EHR?

 

Any insights, best practices, or 'lessons learned' would be immensely helpful as we develop a strategy to reclaim our RNs' time.

 

Thank you in advance for your time and input!

------------------------------
Tony Kostelnak RN, GERO-BC
Sr. Manager, Nursing Strategy
Oak Street Health (part of CVS Health)
------------------------------

Thanks, Torie. Very helpful. In your system, how do central pharm techs become aware that a prior authorization is needed? 

------------------------------
Tony Kostelnak RN, GERO-BC
Sr. Manager, Nursing Strategy
Oak Street Health (part of CVS Health)
------------------------------

Original Message:
Sent: 10-10-2025 06:53
From: Torie Bonnet
Subject: Medication Prior Authorizations

Hi Tony,

We have our Pharmacy Techs in a central hub doing all of our PAs. I have also had great success with Medical Assistants learning this role and doing a centralized model with MA's leading the charge. I do think that to properly fill out a PA it helps to have some training of the medical field. There is a lot of chart-combing that can go into these PAs (I have done many especially for diabetes supplies and they can be a bear). Clinical knowledge paired with a solid training program and utilizing the tools that are out there like CoverMyMeds will help you be successful. We also implemented an electronic signature system through Adobe so that if a paper PA came through or a company had a specific form they required, we could wire the paperwork to the provider electronically so the person doing the PA's did not have to be in the same room as the provider who was signing. 

Happy to discuss further if you have questions! 

------------------------------
Torie Bonnet MSN RN NE-BC NPD-BC
Associate Director of Nursing
Piedmont Health
Raleigh NC

bonnett@piedmonthealth.org

Original Message:
Sent: 10-09-2025 07:42
From: Anthony Kostelnak
Subject: Medication Prior Authorizations

Good morning everyone,

Currently, our RNs are handling all medication PAs, and it's proving to be a significant drain on their clinical time. 

 

We're a large, multi-state organization (27 states) and have established central departments that manage various administrative functions. We're exploring two potential solutions for offloading this work:

• Non-Clinical Staff: Has anyone successfully transitioned medication PAs from RNs to non-clinical staff (e.g., medical assistants, pharmacy technicians, or dedicated PA specialists)? If so, what were the key challenges and necessary training/oversight required?
• Centralized Resource: Does anyone have experience moving this work to a centralized department or team that manages PAs for multiple clinics/states? What was the organizational structure and process flow that made this successful?

For those of you using Epic, how are the critical pieces of information - such as the PA status, the need for a PA, and the final approval/denial-communicated effectively and reliably between a central team and the ordering provider/clinical team within the EHR?

 

Any insights, best practices, or 'lessons learned' would be immensely helpful as we develop a strategy to reclaim our RNs' time.

 

Thank you in advance for your time and input!

------------------------------
Tony Kostelnak RN, GERO-BC
Sr. Manager, Nursing Strategy
Oak Street Health (part of CVS Health)
------------------------------

Currently our requests come through fax and CoverMyMeds. We are on Athena EHR, but just signed a contract for Epic beginning in August. When I had Epic at my previous employer, requests came via fax, CoverMyMeds, and via Epic PA function. 

------------------------------
Torie Bonnet MSN RN NE-BC NPD-BC
Associate Director of Nursing
Piedmont Health
Raleigh NC

bonnett@piedmonthealth.org
------------------------------

Original Message:
Sent: 10-16-2025 07:40
From: Anthony Kostelnak
Subject: Medication Prior Authorizations

Thanks, Torie. Very helpful. In your system, how do central pharm techs become aware that a prior authorization is needed? 

------------------------------
Tony Kostelnak RN, GERO-BC
Sr. Manager, Nursing Strategy
Oak Street Health (part of CVS Health)

Original Message:
Sent: 10-10-2025 06:53
From: Torie Bonnet
Subject: Medication Prior Authorizations

Hi Tony,

We have our Pharmacy Techs in a central hub doing all of our PAs. I have also had great success with Medical Assistants learning this role and doing a centralized model with MA's leading the charge. I do think that to properly fill out a PA it helps to have some training of the medical field. There is a lot of chart-combing that can go into these PAs (I have done many especially for diabetes supplies and they can be a bear). Clinical knowledge paired with a solid training program and utilizing the tools that are out there like CoverMyMeds will help you be successful. We also implemented an electronic signature system through Adobe so that if a paper PA came through or a company had a specific form they required, we could wire the paperwork to the provider electronically so the person doing the PA's did not have to be in the same room as the provider who was signing. 

Happy to discuss further if you have questions! 

------------------------------
Torie Bonnet MSN RN NE-BC NPD-BC
Associate Director of Nursing
Piedmont Health
Raleigh NC

bonnett@piedmonthealth.org

Original Message:
Sent: 10-09-2025 07:42
From: Anthony Kostelnak
Subject: Medication Prior Authorizations

Good morning everyone,

Currently, our RNs are handling all medication PAs, and it's proving to be a significant drain on their clinical time. 

 

We're a large, multi-state organization (27 states) and have established central departments that manage various administrative functions. We're exploring two potential solutions for offloading this work:

• Non-Clinical Staff: Has anyone successfully transitioned medication PAs from RNs to non-clinical staff (e.g., medical assistants, pharmacy technicians, or dedicated PA specialists)? If so, what were the key challenges and necessary training/oversight required?
• Centralized Resource: Does anyone have experience moving this work to a centralized department or team that manages PAs for multiple clinics/states? What was the organizational structure and process flow that made this successful?

For those of you using Epic, how are the critical pieces of information - such as the PA status, the need for a PA, and the final approval/denial-communicated effectively and reliably between a central team and the ordering provider/clinical team within the EHR?

 

Any insights, best practices, or 'lessons learned' would be immensely helpful as we develop a strategy to reclaim our RNs' time.

 

Thank you in advance for your time and input!

------------------------------
Tony Kostelnak RN, GERO-BC
Sr. Manager, Nursing Strategy
Oak Street Health (part of CVS Health)
------------------------------

In my clinic, the non-RN clinical staff do PAs and refill requests. It's working well - the RNs get involved when a letter of appeal is needed. One drawback is that the MAs and LVNs don't always realize that a formulary alternative or workaround (such as ordering combo meds like ciprodex drops as two separate meds) will work and is a way to avoid having to do a PA. Another drawback is that on busy weeks when they are constantly having to room patients they can fall behind which can delay some requests or result in multiple fax messages and reminder calls, which can result in duplicate work. But overall, it's been wonderful for the nurses. I don't think our clinical staff enjoy the extra work, but some of them like the opportunity to learn and have become quite adept, which can be a source of pride for them. This has also freed up our nurses to work nearer the top of our scopes.

------------------------------
Ingrid Hawkinson
RN, MSN, AMB-BC
UCSF Otolaryngology
San Francisco CA
415-353-2148
------------------------------

Original Message:
Sent: 10-09-2025 07:42
From: Anthony Kostelnak
Subject: Medication Prior Authorizations

Good morning everyone,

Currently, our RNs are handling all medication PAs, and it's proving to be a significant drain on their clinical time. 

 

We're a large, multi-state organization (27 states) and have established central departments that manage various administrative functions. We're exploring two potential solutions for offloading this work:

• Non-Clinical Staff: Has anyone successfully transitioned medication PAs from RNs to non-clinical staff (e.g., medical assistants, pharmacy technicians, or dedicated PA specialists)? If so, what were the key challenges and necessary training/oversight required?
• Centralized Resource: Does anyone have experience moving this work to a centralized department or team that manages PAs for multiple clinics/states? What was the organizational structure and process flow that made this successful?

For those of you using Epic, how are the critical pieces of information - such as the PA status, the need for a PA, and the final approval/denial-communicated effectively and reliably between a central team and the ordering provider/clinical team within the EHR?

 

Any insights, best practices, or 'lessons learned' would be immensely helpful as we develop a strategy to reclaim our RNs' time.

 

Thank you in advance for your time and input!

------------------------------
Tony Kostelnak RN, GERO-BC
Sr. Manager, Nursing Strategy
Oak Street Health (part of CVS Health)
------------------------------