Prior Authorization to Manage Drug Utilization and Costs

Transforming Prior Authorization to Decision Support.

PURPOSE To evaluate a computer-based prior authorization system that was designed to include and test two new concepts for physician review: (1) the tool would minimize denials by providing real-time decision support with alternative options if the original request was noncompliant, and (2) the tool would collect sufficient information to create a patient registry. METHODS A new prior authori...

SOAC Engine: A System to Manage Composite Web Service Authorization

Resource Utilization and Costs of Care prior to ART Initiation for Pediatric Patients in Zambia

Objective. We estimated time to initiation, outpatient resource use, and costs of outpatient care during the 6 months prior to ART initiation for HIV-infected pediatric patients in Zambia. Methods. We enrolled 1,102 children who initiated ART at <15 years of age between 2006 and 2011 at 5 study sites. Of these, 832 initiated ART ≤6 months after first presenting to care at the study sites. Data ...

Uncompensated medical provider costs associated with prior authorization for prescription medications in an HIV clinic.

Although prior authorization (PA) for prescription medications is widely employed for cost-containment for third-party insurers, it is a frustrating aspect of outpatient clinical care that imposes uncompensated costs to medical providers. To characterize these costs, we monitored the PA-associated administrative and operational process at the University of Alabama at Birmingham 1917 HIV Clinic ...

A physician-friendly alternative to prior authorization for prescription drugs.

OBJECTIVE To determine if the instant approval (IA) process differs from the traditional prior authorization (PA) process in preferred drug channeling, resultant gaps in therapy, and provider dissatisfaction. STUDY DESIGN An interrupted time series analysis using pharmacy claims and a retrospective cohort study. METHODS The study assessed changes in preferred drug use and subsequent cost re...