Examining the prior authorization process, patient outcomes, and the impact of a pharmacy intervention: A single-center review

Popatia, Sabrina; Flood, Kelsey S.; Golbari, Nicole M.; Patel, Parth; Olbricht, Suzanne M.; Kimball, Alexa B.; Porter, Martina L.

doi:10.1016/j.jaad.2019.05.024

Cited by 14 publications

(17 citation statements)

References 12 publications

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“…While several studies have examined initiatives to improve the PA process [ 3 , 11 – 14 ], this study is the first to examine the implementation of an auto-referral process. To our knowledge, our study is also the first to specifically examine implementation outcomes associated with initiatives to improve the PA process.…”

Section: Discussionmentioning

confidence: 99%

“…This process is often seen as burdensome by patients and clinicians and may lead to treatment delays, administrative costs, and workflow burden. However, the literature on this topic is mixed with some studies showing a reduction in cost for patients [ 2 ] while others have shown high costs for patients and providers [ 3 , 4 ]. Additionally, there has also been mixed reports of impact on patient outcomes [ 2 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Evaluating implementation outcomes (acceptability, adoption, and feasibility) of two initiatives to improve the medication prior authorization process

Jones

Ladd

Gregor

et al. 2021

BMC Health Serv Res

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Background Processes such as prior authorization (PA) for medications, implemented by health insurance companies to ensure that safe, appropriate, cost-effective, and evidence-based care is provided to all members, have created inefficiencies within healthcare systems. Thus, healthcare systems have implemented supplemental processes to reduce burden and ensure efficiency, timeliness, and appropriate care. Objective Evaluate implementation outcomes of two initiatives related to PA for medications: a common record that records all PA-related information that was integrated into the health record and an auto-routing of specialty prescriptions to a hospital-owned specialty pharmacy. Methods We conducted semi-structured interviews with medical staff to understand their experience, acceptability, adoption, and feasibility of these initiatives guided by Proctor’s Framework for Implementation Outcomes. Transcripts were analyzed using consensus coding. Results Eleven medical staff participated in semi-structured interviews. The two initiatives were analyzed together because the findings were similar across both for our outcomes of acceptability, adoption, and feasibility. Participants found the implemented initiatives to be acceptable and beneficial but felt there were still challenges with the new workflow. The initiatives were fully adopted by only one clinic site within the healthcare system, but limitations arose when adopting to another site. Individuals felt the initiatives were feasible and improved workflow, communication, and transparency. However, participants described future adaptations that would help improve this process including improved standardization, automation, and transparency. Conclusion The acceptability, adoption, and feasibility of two initiatives to improve the PA process within the one clinical site were well received but issues of generalizability limited the initiatives adoption system wide.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluating implementation outcomes (acceptability, adoption, and feasibility) of two initiatives to improve the medication prior authorization process

Jones

Ladd

Gregor

et al. 2021

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Our model aligns with other programs that have shown pharmacy involvement in the PA process leads to reduced time to PA submission and completion while increasing approval rates, and ultimately reducing the time to medication access (Figure 4). 12 A total of 11 interns supported the program; each intern worked an average of 1 full shift per week and completed 2 PA related tasks per hour. Interns had regular check-in meetings with the pharmacy manager to review progress, obtain feedback, and improve processes.…”

Section: Prior Authorization Centralizationmentioning

confidence: 99%

Section: Expansion Of Pharmacy Services To Fill Service Gaps During A...mentioning

confidence: 99%

Expansion of Pharmacy Services During COVID-19: Pharmacists and Pharmacy Extenders Filling the Gaps Through Telehealth Services

et al. 2021

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Purpose: The Coronavirus 2019 (COVID-19) pandemic created a significant disruption in healthcare. In our health-system located in New York City, the provision of care in the ambulatory care setting moved to a remote model virtually overnight. We describe interventions made during the pandemic to transform ambulatory care pharmacy through expansion of telehealth services. Summary: In March of 2020, the closure of primary care clinics and provider appointment cancellations due to inpatient redeployment created a void. Collaboration with other health care providers and development of standardized telehealth workflows served as a conduit for creating new roles and opportunities for pharmacy team members. Three main interventions where the pharmacy team filled gaps include; (1) Expansion of pharmacist telemedicine visits for high-risk patients to improve access to primary care visits, (2) Partnership with nursing to create a centralized refill call center workflow, (3) Integration of pharmacy extenders into the prior authorization process to prevent medication access issues. Existing collaborative practice agreements for chronic disease management were utilized. A virtual pharmacist model for patient care contributed to an increase in telehealth visits from 51 in 2019 to 2997 total visits in 2020. In addition, the health-system refill call center expanded its services through collaboration with our pharmacy team. Pharmacists and pharmacy interns partnered with nurse practitioners to improve the call center workflow and address the significant increase in refill requests during the outbreak. Furthermore, a prior authorization process was created across multiple ambulatory care clinics to expedite medication access and prevent delays in therapy. Conclusion: Our ambulatory care pharmacy team leveraged technology, innovative workflows, and collaborative teamwork to catalyze a shift in pharmacists’ and pharmacy extenders’ roles in healthcare delivery to expeditiously meet patients’ needs during a pandemic.

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“…Would it be ethical for me to pass on the costs of PAs to my patients? eFrustrated Dear Frustrated: Although PAs are time consuming and expensive, [1][2][3] the ethics of charging patients for them is problematic and involves the principles of beneficence, nonmaleficence, and justice.…”

mentioning

confidence: 99%

The ethics of charging patients for prior authorizations

Muzumdar

Grant‐Kels

Feng

2020

Journal of the American Academy of Dermatology

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Examining the prior authorization process, patient outcomes, and the impact of a pharmacy intervention: A single-center review

Cited by 14 publications

References 12 publications

Evaluating implementation outcomes (acceptability, adoption, and feasibility) of two initiatives to improve the medication prior authorization process

Evaluating implementation outcomes (acceptability, adoption, and feasibility) of two initiatives to improve the medication prior authorization process

Expansion of Pharmacy Services During COVID-19: Pharmacists and Pharmacy Extenders Filling the Gaps Through Telehealth Services

The ethics of charging patients for prior authorizations

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