Reach Every Practice Early: Notifications and Field Reimbursement, Hand in Glove
When the field can’t be everywhere, the support still can
Pharmaceutical vice presidents, executive directors, brand leads, market access leads, patient support, and field reimbursement leadership:
A prescription leaves the office written correctly, for the right patient, and comes back from the pharmacy a few days later marked prior authorization required. Nobody in the office knew the plan wanted one. The staff member who picks it up has a queue of other patients’ paperwork, the physician has a covered alternative in mind, and the patient is waiting. This is the moment field reimbursement managers exist for. They are the person a brand sends into an office to handle the situation and get this unstuck, and they are good at it.
The office does not know the prior authorization requirements. The practice is buried in appeals. A payer changed its criteria, and nobody noticed. Those problems are real, local, and solvable in person; and the field reimbursement manager is the person a brand sends to solve them. That person can only be in a handful of offices in a week. The problems happen in thousands of them, and most of those offices never call.
The problems the field hears about are the ones that speak up
The burden the field works against is well documented. Physicians complete an average of 43 prior authorizations per week, consuming around 12 hours of physician and staff time. Among physicians surveyed, 95% report that prior authorization delays care; and 79% report that it leads patients to abandon treatment.[1]
The field may know about problem cases: A hub flags an enrollment that stalled. A representative passes along what an office said. A practice calls. Every one of those paths depends on someone noticing a problem and speaking up about it, and the offices that speak up are rarely the offices losing the most patients. The ones that complain well get help. The quiet ones get a new prescriber habit.
Most winnable denials are never appealed, and nobody reports them
In Medicare Advantage in 2024, insurers made 52.8 million prior authorization determinations and denied 4.1 million. Of the denials that were appealed, 80.7% were overturned. But only 11.5% of denials were ever appealed at all.[2]
Somewhere in every territory are offices sitting on denials that would be overturned if fought, and the offices most in need of help are, by definition, the ones not fighting, not calling, not showing up in anyone’s escalation queue. A field plan built on inbound requests cannot see them. It starts with not knowing what you don’t know.
There is a second cost. By the time an office reaches the field, it has usually already drawn its conclusion about the brand. An office’s opinion of a therapy is formed by its first few rejections, and it is formed whether or not anyone from the brand was there when they happened.
A single rejection and a pattern of rejections need different answers
Access problems come at different scales, and the scale decides who should act.
The individual event. One prescription, one office, one rejection with a reason code and a recovery path. There are thousands of these a week, and no field team can chase them one by one. Events want automation: The rejection reaches the practice with the reason and the resource attached, in the channels the care team already uses.
The pattern behind the events. Rejections clustering around one payer’s new criteria. Stalled prior authorizations concentrated in one health system. A region where reversals are climbing. Patterns are where a person in the room changes things: training the office, working the payer relationship, fixing the process that keeps producing the events. Patterns want a field reimbursement manager.
Hand in glove: the notification reaches every practice; the field works the pattern
The notification handles the event, and it does so on its own. A notification goes when the rejection is adjudicated, to the individual practice, with the reason and the fix. Across a network of 3.3 million opted-in clinicians and care-team staff, that is the answer to a problem that arrives thousands of times a week and that no team could reach in person. The results show up in the brand’s dispense rate whether or not a field reimbursement manager ever visits the office.
The field handles the pattern, and the notification reinforces the habit. Call the habit Rx and PA hygiene: getting prescriptions and prior authorizations right the first time and recovering well when a rejection happens anyway. A notification reinforces what good looks like. A field reimbursement manager in the room is what turns repetitions into a habit, at the practices where the pattern says it matters most. Neither replaces the other.
The same reporting that drives the notifications also shows where the rejections and reversals are clustering, by organization, payer, and geography, refreshed each week. That is the add-on worth building with a field team: a shared view of where the patterns are so the field’s time goes where a notification alone is not enough and the field can see, over time, whether its work is moving the numbers.
Picture one payer adding a step-therapy requirement for a brand. That week, every affected office in the network gets the notification with the new requirement and the resubmission path attached, and most of them handle it. The field reimbursement manager takes the offices where the resubmissions still are not landing.
Where the gap is
Most brands have built real visibility into their prescriptions: specialty pharmacy reporting, hub reporting, the field’s own escalations. Those systems see the prescriptions and patients that are already inside them, and they see them well. The gap is at the edges. The prescription rejected at a retail pharmacy the brand has no contract with. The office that never enrolled the patient. The reversal nobody escalated. A notification network built on opted-in clinicians sees the payer’s answer on those prescriptions, too, and reaches the office that wrote them, whether or not that office is on anyone’s list.
What gets measured
A notification program’s performance is read the way a brand reads any pull-through program: dispense rates, before and after the platform starts and against a retroactive control group of prescribers who received no notifications. Dispense rate is reported as a share of all prescriptions, of resubmitted prescriptions, and of patients prescribed, alongside prescription volume and prior authorization rejection rates, and, for brands running refill notifications, refills authorized per prescription. The dashboard updates weekly, with monthly results against the baseline before the platform started, by organization and geography. Timeliness of the dashboards enables the platform and the reimbursement team to be nimble and pivot where and when necessary.
This is what ReCaptRx™ does
ReCaptRx watches the prescription journey for the rejection, the reversal, and the fill that never happened and notifies the prescriber and their team in the channels they already use, with the reason and the resource attached, across a network of 3.3 million opted-in clinicians. A Prescription Journey Audit shows where a brand’s prescriptions are being lost before the platform turns on. Once it is on, the same reporting gives field reimbursement leadership the picture of where the patterns are—so the people go where a person makes the difference.
If your field team is carrying more than it can reach, Dave welcomes the conversation: dave.dierk@aventriahealth.com.
Dave Dierk is Co-President of Aventria Health Group and a 30-year thought leader in pharmaceutical sales and marketing. To learn more about how Aventria can help your brand close the gap between prescription and patient, reach out directly: dave.dierk@aventriahealth.com.
References
American Medical Association. 2025 prior authorization physician survey. May 13, 2026. Accessed September 16, 2026. https://www.ama-assn.org/practice-management/prior-authorization/ama-prior-authorization-physician-survey
Biniek JF, Sroczynski N, Freed M, Neuman T. Medicare Advantage insurers made nearly 53 million prior authorization determinations in 2024. KFF. January 28, 2026. Accessed September 16, 2026. https://www.kff.org/medicare/medicare-advantage-insurers-made-nearly-53-million-prior-authorization-determinations-in-2024/
