How a specialty pharmacy increased prescription fill rate by 26%

Overview

A specialty pharmacy that coordinates prior authorizations, benefits investigations, and ongoing patient support. They operate a small call center that historically devoted significant time to hold queues for PA status checks.

The problem

PA status checks couldn't be done in real time, putting starts and renewals at risk.

As patient volume grew, the team struggled to keep up with prior authorization submission, appeals and status checks. Slow visibility into decisions drove average dispense times to around four days, putting patients at risk of abandoning therapy before their first fill. To cut time-to-therapy and prevent renewal drop-offs, the pharmacy needed a way to scale operations and close information gaps in near real time.

The solution

CareLink's automation reclaims hours of staff time weekly while improving patient experience.

CareLink partnered with the pharmacy to implement a PA and BV automation layer integrated directly into their workflow. Beginning with high-volume payers, real-time phone endpoints were set up and rolled out in phases.

Outbound prior auth call automation

• Dials payers, navigates IVRs, waits on hold, and authenticates from case data.
• Captures the decision and next steps (submitted, pending, approved, denied, need-info) with structured notes including rep, reference number and timestamp.
• Returns outcomes to the PMS or CRM and triggers tasks for missing items such as labs, chart notes and prior therapy.

Proactive SMS for missing info and renewals

• Two-way SMS to collect required documents, confirm details, and nudge prescribers and patients.
• PA renewal reminders, plus copay and PAP re-enrollment, to prevent avoidable lapses.
• Escalation rules for sensitive or non-responsive cases.

Ops and governance

• Dashboards for abandonment at the PA stage, median time from Rx to PA decision, percentage of need-info cases resolved under 72 hours, 90-day persistence by cohort, and renewal capture.
• PHI and consent management, transcripts and audit logs, and pharmacy-specific templates.

Results

The implementation delivered significant time savings and faster turnaround for the specialty pharmacy.

Reduced PA-stage abandonment

Faster status retrieval and immediate info collection reduced abandonment by 26%.

Faster time to therapy

Shrinking pending time and closing information gaps accelerated Rx-to-PA decisions by one to two days.

Operational efficiency

Teams reclaimed an average of 24 minutes per case from eliminated hold time and simpler documentation. That time was redirected to appeals prep and complex cases.

Actionable insights

Dashboards exposed payer-specific choke points, enabling targeted fixes and improvements over time.