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

Abstract

Background: Dermatology experiences a disproportionately high burden of prior authorizations (PAs).

Objective: To examine the effect of a centralized pharmacy intervention on the PA process and the impact of PAs on patient outcomes.

Methods: A retrospective review of PAs submitted for medications before and after implementation of pharmacy intervention was conducted.

Results: PA was required for 8.1% of all prescriptions. PAs were most frequently submitted for topical steroids, topical antibiotics and antifungals, and topical retinoids. Most common indications included acne, psoriasis, and dermatitis. Biologic agents (55.2%) and brand-name only medications (42.8%) required PA at higher rates. Pharmacy intervention resulted in shorter time to PA submission (4 days vs 1 day, P < .001) and decision (6 days vs 1 day, P < .001) and higher approval rates (63.9% vs 80.6%, P < .001) but did not decrease the total number of PAs. Patients with approved PAs had higher likelihood of disease improvement vs those with denied PAs (71.1% vs 58.0%, P = .013).

Limitations: Data were collected from a single academic institution. Patient medication compliance was not assessed.

Conclusions: The current PA process may result in delays in care and a negative impact on patients. A centralized pharmacy intervention is an effective measure but does not eliminate the overall burden of PAs.

Keywords: drugs; medications; patient outcomes; pharmacy; pharmacy intervention; prior authorization.