Perceptions of Saskatchewan Community Pharmacists Regarding a Prior-Authorization Program

Abstract

Background:In1999,SaskatchewanHealth authorized pharmacists to initiate exception drug status (EdS)requests,also knownasprior authorization (Pa).Before 1999,onlythose licensedtoprescribe medications were authorizedtoinitiate EdSrequests. apharmacistwho submitsan EdSrequest must obtain apatientdiagnosis fromthe physicianoragent of thephysician; adiagnosis presented by thepatientisinsufficient. oBjEctIvE: to obtain pharmacists'opinionsabout thebenefitsofthe Pa programofthe SaskatchewandrugPlanand to identify factorsassociated with pharmacist-initiatedEdS requests.MEtHodS:acensus survey of community pharmacy managerswas conducted viaaself-administered postalquestionnaireinthe province of Saskatchewan, canada,inthe fall of 2004.the survey questionnairewas addressedtopharmacy managers, some of whom mayhavedelegated the response to astaff pharmacist. Pharmacy managersortheirdelegates were askedtorespond on behalf of allpharmacists in their pharmacies.rESuLtS:aresponse rate of 82.6%was achieved(275/333). amajority of respondentsagreedthatthe province's Pa program(EdS) benefited patients (87.3%)and theSaskatchewandrugPlan(82.5%),whereas only 33.4%ofrespondentsagreedthatthe EdSprogram benefited pharmacists.Pharmacists'ability to obtain therequisite information(87.6%) and to contactthe prescribingphysician(87.3%),aswellaspatient-centered concerns such as thepatient'sability to payfor theprescription (85.1%), were themostimportant factors. thetime required by thepharmacisttoinitiate therequest wasnot important relativetoother factors. community pharmacies reported receiptofanaverage of 36.4 prescriptionsfor restricted andnonformularydrugs per week,ofwhich 22 were submittedfor Pa coverage,1 7bythe pharmacy and5bythe pharmacy at therequest of thephysician.concLuSIonS:the resultsofthisstudy indicate that community pharmacists in Saskatchewanacknowledge that theEdS process is beneficial for their patients.However,pharmacists areburdenedbyanadministrative process in whichnecessary information, particularlythe patientdiagnosis, is notreadilyavailable. What is alreadyknown aboutthissubjectWhat this studyadds M edicareinCanadaisaf ederal programthathas evolved over nearly40years to provideCanadiansaccesstomedicallyn ecessary physician andh ospitals ervices, includingdrugs administered in hospitals. However, each provincial and territorialg overnmenti ndependently developeda nd continuest o developp rogramst op rovide drug coveragef or some or allo fi ts residentsinthe communityorinnonhospital facilities.The federal government hasalsodeveloped andcontinuestodevelop drug programsf or select groups,including veterans andF irst Nations and Inuitpeoples.However,morethanhalfofall prescriptionsare paid throughprivate insuranceordirectly by individualsorpatients. 1,2 In 2005,Canadahad 7,778community pharmacies comprising chaina nd banner pharmacies (58.6%), independent pharmacies (21.4%), andpharmaciesinfood andmass merchandisers (20.0%). 3 In 2005 in Saskatchewan, public fundspaidfor 48%ofthe $554 perc apitas pent on prescriptio...

Professional Pharmacy Services and Patient Complexity: An Observational Study

“…Furthermore, because pharmacy reimbursement for services is not tied to patient complexity, some pharmacists may be deterred from providing these services to highly complex patients taking multiple medications given the time commitment required to conduct the service (17). The introduction of new PPS in Alberta and Saskatchewan revealed varying levels of acceptability from pharmacists based on factors including the perception of the ability of services to improve patient care, easy incorporation into workflow, ability to provide adequate follow-up and liability (18,19). Prevalence of Ontario Drug Benefit beneficiaries receiving one or more professional pharmacy services by patient complexity, broken down by professional pharmacy service type between April 2012 and March 2013.…”

Evaluating the introduction of a computerized prior‐authorization system on the completeness of drug exposure data

“…11 We took advantage of a natural experiment, whereby on July 1, 2006, Saskatchewan's public drug plan implemented an automated online adjudicated procedure for the prior authorization (in Saskatchewan, prior authorization is called exception drug status) for the antidiabetic medications rosiglitazone and pioglitazone (thiazolidinediones [TZDs]). 12 Previously, TZD prior authorization was completed through a paper-based process via phone, fax, or mail. Patients who had previously failed to achieve adequate glucose control or were intolerant to metformin or sulfonylurea therapy met the prior-authorization criteria.…”

Evaluating the impact of a novel restricted reimbursement policy for quinolone antibiotics: A time series analysis

“…Traditional prior authorization programs have been shown to reduce prescription rates of several classes of medications including COX II inhibitors [2,3], respiratory drugs [4,5] and antidepressant agents [6]. However, they have been criticized as being intrusive [7], time-consuming, expensive to administer, and their effects may be temporary [8]. …”