Implementation of a comprehensive medication prior-authorization service

Leinss, Robert; Karpinski, Todd; Patel, Binita

doi:10.2146/ajhp130786

Cited by 16 publications

(12 citation statements)

References 1 publication

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“…[8][9][10] Triggers for medication PA typically include high medication cost, frequent off-label use, high toxicity, and potentially harmful drug interactions, all common in pediatric hematology and oncology (PHO). [11][12][13][14] Pediatr Blood Cancer 2016; 00: [1][2][3][4] c 2016 Wiley Periodicals, Inc. 1 wileyonlinelibrary.com/journal/pbc Therefore, it is reasonable to suspect that the PA process is commonly encountered in this subspecialty. No published information exists regarding the relative frequency of PAs and consequent impact on overall costs, burden of care, and clinical outcomes in PHO.…”

Section: Introductionmentioning

confidence: 99%

Medication prior authorization in pediatric hematology and oncology

Dickens

Pollock

2016

Pediatric Blood & Cancer

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Background: Medication prior authorization (PA) is a commonly occurring requirement, particularly for medications used for rare conditions. Based on standard definitions, cancer and many blood disorders affecting children are rare. The study aims were to describe the relative frequency of PA requests and their association with payers and medications in order to identify opportunities to improve system efficiency. Procedure:Requests for medication PA were logged prospectively for patients seen at a single institution over a 7-month period. Period prevalence was used to estimate the relative frequency of PA requests. Descriptive statistics summarized the relationship among payers, medications, and approvals relative to the frequency of PA requests. Results:For the study duration of 150 clinic days, there were 5,583 patient visits. A total of 142 medication PA requests were received resulting in a period prevalence rate of 2.5% patient visits. Of the 137 medication PA requests with available outcome data, 135 (98.5%) were ultimately approved with additional provider efforts. The median clinic staff time spent per request was 46 min with an interquartile range of 25-80 min. There was striking process heterogeneity among different payers. Conclusion:Virtually no medication PA request in pediatric hematology and oncology (PHO) leads to alterations in care. Medication utilization management strategies in PHO fail to provide benefits reported in other areas of medicine and have unmeasured negative effects on timeliness of care and parenteral psychological/emotional health. There is opportunity for increasing efficiency through payer and provider collaboration on the creation of prescribing standards for PHO patients.

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Section: Introductionmentioning

confidence: 99%

Medication prior authorization in pediatric hematology and oncology

Dickens

Pollock

2016

Pediatric Blood & Cancer

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“…Pharmacy technicians and/or other support personnel can be integral in carrying out the plan of care designed by the clinical pharmacist and interprofessional health care team by supporting patient assistance programs, entering orders, facilitating transitions of care, communicating cancellation of refills for discontinued medications, authorizing refills according to established protocols, helping with prior authorizations or nonformulary requests, organizing and stocking patient education materials, administering immunizations to patients, and assisting with medication delivery to the bedside before discharge in hospitalized patients . In both hospital and community settings, it is well established that pharmacy technicians enter medication orders into the electronic medical record for pharmacist review and approval.…”

Section: Recommendation 3: Incorporate Support Personnel Into Approprmentioning

confidence: 99%

“…Technicians and support personnel with experience in billing and coding have been used in specialty pharmacies to support daily operations . In addition to managing the prior authorization process, technicians assist with financial assessments, coordinate case management activities, facilitate refill and medication delivery, document education in the electronic medical record, and assist with adherence monitoring …”

Section: Recommendation 4: Incorporate Support Personnel Into Ancillamentioning

confidence: 99%

“…84 Technicians and support personnel with experience in billing and coding have been used in specialty pharmacies to support daily operations. 32,86 In addition to managing the prior authorization process, technicians assist with financial assessments, coordinate case management activities, facilitate refill and medication delivery, document education in the electronic medical record, and assist with adherence monitoring. 51,86,87 To support quality improvement activities and pharmacy operations, data analyst functions performed by support personnel include running monthly reports on drug use patterns to assess financial impact, compiling and administering satisfaction surveys to obtain feedback on clinical pharmacy services, and assessing outcomes of institutional initiatives and quality improvement reporting.…”

Section: Documentationmentioning

confidence: 99%

“…Skills, together with documented evidence of effectiveness in the respective role, should be considered. Pharmacy technicians and other support personnel have long played a vital role in drug distribution, compounding, billing, and inventory management, and although some published literature has identified non‐pharmacy staff as better suited for tasks such as billing and coding or prior authorization, ample published data document their effectiveness in a variety of roles that align with components of the clinical pharmacist's process of care (Table ). Collaborations with other health care personnel (eg, nurse‐pharmacist collaborations) should also be considered, depending on the workflow and staffing within a particular practice setting.…”

Section: Recommendation 1: Identify the Appropriate Support Personnelmentioning

confidence: 99%

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Best practices: Incorporating pharmacy technicians and other support personnel into the clinical pharmacist's process of care

Borchert

Phillips

Bastin

et al. 2018

J Am Coll Clin Pharm

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Changes to the U.S. health care landscape have increased the focus on the quality and use of alternative payment models, with a growing focus on value. As health care costs continue to rise, clinical pharmacists will increasingly engage in roles to expand the breadth and depth of clinical services in providing comprehensive medication management (CMM) to improve patient outcomes. The roles of pharmacy technicians and other support personnel must evolve to meet the needs created by this practice change and allow pharmacists to focus their services on activities that use their expertise to improve medication outcomes. Support personnel, including pharmacy technicians, should be identified to assist with clinical pharmacy tasks on the basis of their skills. To ensure competence, support personnel should be adequately trained and (if applicable) certified. Moreover, support personnel should be optimally incorporated into appropriate components of the clinical pharmacist's process of care to expand the reach and depth of clinical pharmacy services. When supervised by the pharmacist or others as defined in state practice acts, support personnel may be able to assist in the clinical pharmacist's provision of CMM. Finally, research should be conducted and disseminated on the utility and outcomes achieved using support personnel in the clinical pharmacist's process of care.

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