Prior Authorizations Play Crucial Role in Ensuring Appropriate Medication Use
By Susan A. Cantrell, RPh, CAE
Prior authorization (PA) is a crucial but often misunderstood utilization management tool in the pharmacy benefit space. The recent bad rap that PAs have received, I believe, comes from misinformation about the process and glitches in specific systems that can be corrected.
This includes examples in Dr. William E. Bennett Jr.’s Oct. 22 opinion piece in the Washington Post where he alleges PA “exists so that many patients will fail to get the medications they need.”
This is certainly not the intent of a well-designed PA program for pharmaceuticals. PAs are not designed as a strategy to save money at the expense of patient care. Rather, they help improve patient outcomes by encouraging the use of appropriate therapies with established evidence of efficacy and safety, and that provide the highest value.
For example, a PA might be applied to opioids as an additional safeguard for their appropriate use or to botulinum toxin to ensure the prescription is for medical, rather than cosmetic, purposes.
Managed care pharmacy professionals strongly believe in PAs as a utilization management tool and have streamlined the process, including by supporting standards-based, electronic-PA transactions and continually assessing best practices. We want to ensure PAs are timely, transparent, and collaborative.
Patients deserve timely, efficient access to appropriate therapies. This is our commitment with PAs.
Susan A. Cantrell is CEO of AMCP, a professional association that represents 8,000 managed care pharmacy professionals who design and implement pharmacy benefits for nearly 300 million Americans.