Prior Authorization for Medication: Unseen Costs

Such authorizations delay patient receipt of medications and pose a substantial burden to healthcare providers.

Healthcare payers are increasingly using restricted formularies and requiring prior authorization for new or expensive medications. Presumably, these strategies save them money, but at what cost to healthcare providers?

Researchers analyzed all 288 prior authorizations for medications that were processed at the University of Alabama HIV outpatient clinic between March 2006 and February 2008. Ninety-five percent of the authorizations involved public insurance programs, including 33 different Medicare Part D plans. Sixty percent of the authorizations were for pain medications, psychotropic medications, and non-HIV anti-infectives, and 13% were for antiretrovirals. Seventy-three percent of all authorizations were approved, 18% were denied, and …

Reviewing Author

Keith Henry, MD

Disclosures

Consultant/Advisory BoardViiV Advisory Board

Editorial BoardsJAIDS: Journal of Acquired Immune Deficiency Syndromes

Keith Henry, MD

Disclosures

Consultant/Advisory BoardViiV Advisory Board

Editorial BoardsJAIDS: Journal of Acquired Immune Deficiency Syndromes

Prior Authorization for Medication: Unseen Costs

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Reviewing Author