Evaluating the effect of prior authorizations in patients with complex dermatologic conditions

Jew, Olivia S.; Okawa, Joyce; Barbieri, John S.; McCaffrey, Joanne; Hayward, Elizabeth; Werth, Victoria P.

doi:10.1016/j.jaad.2020.06.998

Cited by 13 publications

(10 citation statements)

References 11 publications

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“…Prior Authorizations (PAs): Advocacy for streamlining PAs [96] is essential to improve patient survival and outcomes. Further, denials lead to higher insurance company costs [97], as most clinicians finally attain authorization [98]. An organized approach can expedite most procedures and medication authorizations, including an appeal, within 72 h in the US.…”

Section: Implementing the Planmentioning

confidence: 99%

A comprehensive framework for navigating patient care in systemic sclerosis: A global response to the need for improving the practice of diagnostic and preventive strategies in SSc

Saketkoo

Frech

Varjú

et al. 2021

Best Practice & Research Clinical Rheumatology

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Section: Implementing the Planmentioning

confidence: 99%

A comprehensive framework for navigating patient care in systemic sclerosis: A global response to the need for improving the practice of diagnostic and preventive strategies in SSc

Saketkoo

Frech

Varjú

et al. 2021

Best Practice & Research Clinical Rheumatology

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“…Delays in preferred treatment from PAs can cause even higher costs to the healthcare system, especially when the patient suffers from complications or hospitalizations due to the delay in therapy. In a study that analyzed the occurrence of PAs and time to approval, 2 out of 49 patients with dermatologic conditions had to be hospitalized due to repeated PA denials for a medication that their prescriber deemed appropriate 7 . Despite the burden of PA and problems that have arisen from this process, PA requirements have continued to increase.…”

Section: Introductionmentioning

confidence: 99%

“…In a study that analyzed the occurrence of PAs and time to approval, 2 out of 49 patients with dermatologic conditions had to be hospitalized due to repeated PA denials for a medication that their prescriber deemed appropriate. 7 Despite the burden of PA and problems that have arisen from this process, PA requirements have continued to increase. The PA requirements in Medicare Part D plans increased from 8% in 2007 to 24% in 2019.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of prior authorizations in transplant recipients at an urban institution

Muran

Khamo

Patel

et al. 2023

Clinical Transplantation

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Background Increasing prior authorization (PA) requirements for immunosuppression remain a burden for solid organ transplant (SOT) recipients and transplant staff. The objective of this study was to evaluate the number of PAs required and the approval rates at an academic, urban transplant center. Methods This was a retrospective study of SOT recipients at the University of Illinois Hospital and Health Sciences System (UI Health) that required PAs between 11/1/2019 and 12/1/2020. Inclusion criteria were SOT recipients greater than 18 years of age and prescribed a medication by the transplant team that required PA. Duplicate PA requests were excluded from the analysis. Results A total of 879 PAs were included in the study. Of these PAs, 85% (747/879) were approved. Seventy‐four percent of the denials were overturned by an appeal. Most PAs were in black (45.4%), kidney transplant (62%), Medicare (31.7%), and Medicaid recipients (33.2%). The median approval time was 1 day for PAs and 5 days for appeals. Tacrolimus extended release (XR) (35.4%), tacrolimus immediate release (IR) (9.7%),and mycophenolic acid (7%) required most PAs. Black recipients and immunosuppression were identified as predictors of eventual PA approval, whereas recipients with Medicaid were less likely to obtain approval. Conclusions At our transplant center, there was a high approval rate of PAs for immunosuppression, which calls into question the utility of PAs in this patient population, where these medications are standard of care. More black recipients and patients with Medicare and Medicaid had increased PA requirements, highlighting further disparities within the current system.

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“…[5][6][7] Studies have shown that each PA takes a median of 30 to 46 minutes of providers' time to complete and 22 days to process. [8][9][10] Because PAs can lead to prescription access delays and non-adherence, increased total expenditures due to poor health outcomes and social costs may counterbalance the cost savings from PAs. [11][12][13] Due to their demonstrated improvement on medication adherence and disease control, mail order pharmacies are another strategy used by payers to reduce cost and improve adherence.…”

Section: Introductionmentioning

confidence: 99%

“…5 -7 Studies have shown that each PA takes a median of 30 to 46 minutes of providers’ time to complete and 22 days to process. 8 -10 Because PAs can lead to prescription access delays and non-adherence, increased total expenditures due to poor health outcomes and social costs may counterbalance the cost savings from PAs. 11 -13…”

Section: Introductionmentioning

confidence: 99%

The Impact of Electronic Health Record Interventions on Patient Access to Post-Hospital Discharge Prescriptions

et al. 2022

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Purpose: Assess the impact of electronic health record interventions on patient access to post-hospital discharge prescriptions. Methods: Five interventions were implemented in the electronic health record to improve patient access to prescriptions after discharge from hospital: electronic prior authorization, alternative medication suggestions, order sets, mail order pharmacy alerts, and medication interchange instructions. This was a retrospective cohort study of patient responses from discharges during 6 months before the first intervention implementation and 6 months after the last intervention implementation documented in the electronic health record and a transition-in-care platform. Primary endpoint was the proportion of discharges with patient-reported issues that would have been prevented by the studied interventions out of number of discharges with at least one prescription, analyzed using Chi-squared test (level of significance .05). Results: Discharges with patient-reported issues that would have been prevented by the studied interventions decreased from 1.68 to 1.07 out of 1000 discharges with prescriptions ( P < .001). Conclusion: Interventions in the electronic health record reduced barriers faced by patients to picking up prescriptions post-discharge from hospital, potentially leading to improved patient satisfaction and improved health outcomes. Important factors to consider for electronic health record intervention implementation are workflow development and intrusiveness of clinical decision support. Multiple targeted electronic health record interventions can improve patients’ access to prescriptions after discharge from hospital.

show abstract

Evaluating the effect of prior authorizations in patients with complex dermatologic conditions

Cited by 13 publications

References 11 publications

A comprehensive framework for navigating patient care in systemic sclerosis: A global response to the need for improving the practice of diagnostic and preventive strategies in SSc

A comprehensive framework for navigating patient care in systemic sclerosis: A global response to the need for improving the practice of diagnostic and preventive strategies in SSc

Evaluation of prior authorizations in transplant recipients at an urban institution

The Impact of Electronic Health Record Interventions on Patient Access to Post-Hospital Discharge Prescriptions

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