Prior Authorization Programs: A Critical Review of the Literature

MacKinnon, Neil J.; Kumar, Ritu

doi:10.18553/jmcp.2001.7.4.297

Cited by 59 publications

(59 citation statements)

References 19 publications

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Section: What This Study Addsmentioning

confidence: 99%

“…1,2 Patients and providers may perceive a PA as a barrier limiting access and potentially resulting in decreased medication use. 1 In 2011, 76% of 274 employers surveyed by the Pharmacy Benefit Management Institute reported using PA as one of their utilization management tools. 3 A 2010 systematic review of 9 studies assessing pharmacy benefit policies reported that PA policies consistently of type 2 diabetes, has been known to exacerbate congestive heart failure in post-marketing surveillance, and since November 2007, the prescribing information for rosiglitazone specifically recommends against use in combination with nitrates or insulin due to increased risk of myocardial ischemic events.…”

Section: What This Study Addsmentioning

confidence: 99%

See 1 more Smart Citation

Rosiglitazone Prior Authorization Safety Policy: A Cohort Study

Starner¹,

Fenrick²,

Coleman³

et al. 2012

JMCP

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Section: What This Study Addsmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

Rosiglitazone Prior Authorization Safety Policy: A Cohort Study

Starner¹,

Fenrick²,

Coleman³

et al. 2012

JMCP

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“…12 The principal stakeholders in PA programs arepatients, pharmacists, physicians, drug plans, anda dministrators. 28,34,36,39,41 Traditionally, physiciansh aveb eent he health care professionalst hata pply forP Acoveragef or apatient,b ut some drug planssuchasthe Saskatchewan Drug Plan have authorized pharmacistst oa lso initiate PA requests.…”

Section: Discussionmentioning

confidence: 99%

Perceptions of Saskatchewan Community Pharmacists Regarding a Prior-Authorization Program

Perepelkin

Dobson²

2007

JMCP

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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...

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“…There were many articles and web postings citing the legal requirements of the 72-hour emergency drug supply. [3][4][5][6][7][8][9] The purpose of this research was to provide insight as to why some pharmacists and technicians do not provide a 72-hour emergency drug supply when PA cannot be attained.…”

Section: What This Study Adds (Continued)mentioning

confidence: 99%