The doctor writes the prescription. The patient still can't get the pill. Dan Rubin has spent three decades closing that gap.
Prior authorization is the paperwork an insurer demands before it will pay for a drug a doctor already chose. It is medicine's most quietly despised document - hours of faxes, phone trees and denials standing between a written prescription and a filled one. Dan Rubin runs a company built entirely to make that document disappear for the people who hate it most.
As President and CEO of PARx Solutions, Rubin oversees PASS - the Prior Authorization Support System. A physician's office hands the headache to PARx; PARx handles the submissions, the back-and-forth with the plan, the appeals. The twist that makes it work: pharmaceutical brands sponsor the service, so the practice pays nothing. Rubin didn't invent a faster fax machine. He rearranged who pays for the problem.
He has held the top job at PARx since mid-2012, setting strategic direction and working hand-in-hand with the brands and partners that fund the model. The Burlington, Massachusetts company sits at a busy intersection of healthcare IT, physician practice management and pharmaceutical services - all the places where good intentions go to die in administrative friction. Rubin's whole bet is that someone can profitably stand in that gap on the patient's behalf.
Generating high PA approval rates is important - but not sufficient.- Dan Rubin, in Pharmaceutical Executive
Rubin trained as a chemical engineer at MIT, graduating in 1982. Chemical engineers learn to look at a messy process - inputs, bottlenecks, waste, throughput - and ask where the system leaks. He took that habit to Northwestern's Kellogg School for a graduate degree in management, and then pointed it at an unlikely target: not pipelines and reactors, but the path a prescription travels from a doctor's pad to a patient's hand.
That path, it turns out, leaks badly. A drug can be on a plan's formulary and still get denied at the counter. A physician can write exactly the right medicine and watch it stall in a fax queue for days. For an engineer, this is irresistible - a process visibly losing yield at a single, fixable step. Rubin has spent his entire career on that step.
Co-founded and led for fifteen years. A pioneer in patient-adherence communications - reminding patients to keep taking medicine they'd already been prescribed. Same theme, different leak in the pipe.
After Adheris was acquired, Rubin became President of inVentiv's Patient Outcomes division, overseeing Adheris, The Franklin Group and a cluster of prescription-services businesses.
Took over a company aimed squarely at prior authorization. The PASS system turns the most hated form in medicine into someone else's job - paid for by pharma, free to doctors.
Addressing prior-authorization challenges through sales and marketing tactics delivers tangible and substantial benefits.- Dan Rubin, "Tackling the Prior Authorization Challenge"
Rubin writes as well as he operates. In Pharmaceutical Executive he has argued, repeatedly, that the industry treats prior authorization as a clerical nuisance when it is really a commercial chokepoint. A brand can win the formulary battle - get its drug listed, negotiate the contract - and still lose at the pharmacy counter because the prior-auth step strangles the prescription. His pieces carry titles like "Does Formulary Contracting = Patients Will Get Their Prescriptions?" The question mark is the whole point.
His insistence that high approval rates are "important but not sufficient" is the tell of an operator, not a marketer. A vendor brags about its numbers. Rubin keeps pointing past them - to whether the patient, at the end of the whole chain, actually walked out with the medicine. That is the only metric a chemical engineer would accept: did the product come out the other end of the pipe.
Michael Evanisko co-founded Adheris with Rubin in 1993 and now chairs PARx. A working partnership that has outlasted two companies and three decades.
PARx's whole model rests on a counterintuitive idea: the people who use PASS - physician offices - never pay for it. The drug makers do.
He sold a company built on prescription follow-through, then started over against the same foe from a different angle. Persistence as a business plan.