Prior authorizations for medication need to be refocused on their intended use: determining whether new high-cost drugs are appropriate, and not as a cost-saving tool being applied to an increasing number of drugs, according to a recent viewpoint published by JAMA Network.
Jack Resneck Jr., MD, a dermatology professor at the University of California in San Francisco, argued in the viewpoint that expanded use of medication prior authorization has led to care delays and put more administrative burden on physicians.
Dr. Resneck cited MedPAC data that found between 2007-19, prior authorization requirements grew from 8 percent to about 24 percent of covered prescriptions on Medicare Part D plans. Additional data signals that expanded use of medication prior authorization eats up providers' time: Practicing physicians across multiple specialties report completing a mean of 31 prior authorizations for medication each week, according to a 2018 survey from the American Medical Association. Providers spent a mean of 15 hours seeking authorizations.
To reduce the burden of prior authorizations while maintaining health plans' ability to review outlier prescribers and high-cost therapies, Dr. Resneck proposed three solutions:
1. Health plans shouldn't use prior authorization for medications with low final denial rates, no evidence of variation, or no safe or lower-cost alternatives. In addition, health plans should selectively implement prior authorization based on prescribers' prior approval rates, focusing on outliers.
2. Insurers should minimize medication disruptions for patients who are stable with chronic treatment. Protections could include grace periods when patients switch plans and protections from new step-therapy restrictions implemented outside of enrollment periods, Dr. Resneck said.
3. Transparency, efficiency and fairness should be promoted. Dr. Resneck writes that prescribers should be able to access formulary, prior authorization and cost status in a pharmacy benefit tool in real time that interfaces with their EHR.
Read the full viewpoint here.
More articles on healthcare finance:
IRS revokes hospital's tax-exempt status
CMS cuts payments to 786 hospitals over high rates of infection, injury
Pennsylvania hospital loses license