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

Sabrina Popatia; Kelsey S. Flood; Nicole M. Golbari; Parth V. Patel; Suzanne M. Olbricht; Alexa B. Kimball; Martina L. Porter

doi:10.1016/j.jaad.2019.05.024

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

Sabrina Popatia, Kelsey S. Flood, Nicole M. Golbari, Parth V. Patel, Suzanne M. Olbricht, Alexa B. Kimball, Martina L. Porter^*

^*Corresponding author for this work

Dermatology

Research output: Contribution to journal › Article › peer-review

18 Scopus citations

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.

Original language	English (US)
Pages (from-to)	1308-1318
Number of pages	11
Journal	Journal of the American Academy of Dermatology
Volume	81
Issue number	6
DOIs	https://doi.org/10.1016/j.jaad.2019.05.024
State	Published - Dec 2019

Keywords

drugs
medications
patient outcomes
pharmacy
pharmacy intervention
prior authorization

ASJC Scopus subject areas

Dermatology

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10.1016/j.jaad.2019.05.024

Cite this

@article{3060cfc7ed814dc3a0baf1a9a15f3afb,

title = "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",

author = "Sabrina Popatia and Flood, {Kelsey S.} and Golbari, {Nicole M.} and Patel, {Parth V.} and Olbricht, {Suzanne M.} and Kimball, {Alexa B.} and Porter, {Martina L.}",

note = "Funding Information: Funding sources: Dr Porter received the American Academy of Dermatology Resident and Fellow Quality Improvement (QI) Project grant for this project. Funding from this grant was for the implementation of the pharmacy intervention, specifically, office supplies and funding to cover travel for Dr Porter to the 2018 American Academy of Dermatology annual meeting to present the QI project at the QI symposium. No funding from the project was used specifically for the research presented in this article.Conflicts of interest: Dr Flood receives fellowship funding from AbbVie, Janssen, and the National Psoriasis Foundation. Dr Kimball is a consultant and investigator for AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, and receives fellowship funding from AbbVie and Janssen. Dr Porter is a consultant and investigator for AbbVie and Novartis, an investigator for Bristol-Myers Squibb, Eli Lilly, Janssen, and UCB, and has previously received fellowship funding from AbbVie, Janssen, and the National Psoriasis Foundation. Sabrina Popatia, Nicole M. Golbari, Parth V. Patel, and Dr Olbricht have no conflicts of interest to declare. Publisher Copyright: {\textcopyright} 2019 American Academy of Dermatology, Inc.",

year = "2019",

month = dec,

doi = "10.1016/j.jaad.2019.05.024",

language = "English (US)",

volume = "81",

pages = "1308--1318",

journal = "Journal of the American Academy of Dermatology",

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number = "6",

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TY - JOUR

T1 - Examining the prior authorization process, patient outcomes, and the impact of a pharmacy intervention

T2 - A single-center review

AU - Popatia, Sabrina

AU - Flood, Kelsey S.

AU - Golbari, Nicole M.

AU - Patel, Parth V.

AU - Olbricht, Suzanne M.

AU - Kimball, Alexa B.

AU - Porter, Martina L.

N1 - Funding Information: Funding sources: Dr Porter received the American Academy of Dermatology Resident and Fellow Quality Improvement (QI) Project grant for this project. Funding from this grant was for the implementation of the pharmacy intervention, specifically, office supplies and funding to cover travel for Dr Porter to the 2018 American Academy of Dermatology annual meeting to present the QI project at the QI symposium. No funding from the project was used specifically for the research presented in this article.Conflicts of interest: Dr Flood receives fellowship funding from AbbVie, Janssen, and the National Psoriasis Foundation. Dr Kimball is a consultant and investigator for AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, and receives fellowship funding from AbbVie and Janssen. Dr Porter is a consultant and investigator for AbbVie and Novartis, an investigator for Bristol-Myers Squibb, Eli Lilly, Janssen, and UCB, and has previously received fellowship funding from AbbVie, Janssen, and the National Psoriasis Foundation. Sabrina Popatia, Nicole M. Golbari, Parth V. Patel, and Dr Olbricht have no conflicts of interest to declare. Publisher Copyright: © 2019 American Academy of Dermatology, Inc.

PY - 2019/12

Y1 - 2019/12

N2 - 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.

AB - 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.

KW - drugs

KW - medications

KW - patient outcomes

KW - pharmacy

KW - pharmacy intervention

KW - prior authorization

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

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