Impact of pharmacy intervention on prior authorization success and efficiency at a university medical center

Timothy Cutler, Yifan She, Jason Barca, Shawn Lester, Guibo Xing, Jigna Patel, Joy Melnikow

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND: Prior authorizations (PAs) may improve appropriate use of prescription medications. Despite potential savings for health insurance plans, the PA process is time consuming for the ordering provider, pharmacy, and patient. The UC Davis Health System (UCDHS) has created a centralized pharmacy-run clinic PA process. OBJECTIVE: To compare the mean PA processing time between the new centralized clinic and usual care and provide secondary endpoints for PA approval rates, time to prescription fill, time to prescription pick-up, total staff time, and estimated labor costs. METHODS: This is a prospective observational study comparing sequential PA requests at the UCDHS centralized clinic (intervention) and other UCDHS clinics (usual care) between January 1, 2014, and December 31, 2014. The Cochran-Mantel-Haenszel test was used to compare dichotomous outcomes (approval/denial rates) between the 2 groups, controlling for insurance type. A generalized linear model was applied for comparing the continuous outcomes (PA process time, time to first fill, time to pick-up, and cost) with insurance type as covariate. RESULTS: For the intervention group, 47 PAs were evaluated, and 77 PAs were evaluated in the usual care group. The average PA process time was 0.53 days for the intervention group versus 7.02 days for usual care (P < 0.001), and the PA approval rate was 93[%] for the intervention group versus 68[%] for usual care (P < 0.002). The mean time to fill was 2.49 days and 5.52 days for the intervention and usual care clinics, respectively (P = 0.02). The pick-up percentage was 75[%] versus 52[%] for intervention and usual care, respectively (P < 0.001). The intervention clinic spent a significantly lower mean time processing PAs (15 minutes vs. 64 minutes) compared with the usual care clinics (P < 0.001). It is estimated that the mean total labor cost per PA at the intervention clinic was $11.50 compared with $37.50 for the usual care clinics (P < 0.001). CONCLUSIONS: Pharmacy-led interventions in PA processing resulted in a statistically significant benefit in improving time to PA approval, time to first fill, and time to pick-up.

Original languageEnglish (US)
Pages (from-to)1167-1171
Number of pages5
JournalJournal of managed care & specialty pharmacy
Volume22
Issue number10
DOIs
StatePublished - 2016

Fingerprint

Health
Insurance
Processing
Personnel
Health insurance
Costs
Lead
Prescriptions
Costs and Cost Analysis
First Fill
Secondary Care
Health Insurance
Observational Studies
Linear Models
Prospective Studies

ASJC Scopus subject areas

  • Pharmacy
  • Pharmaceutical Science
  • Health Policy

Cite this

Impact of pharmacy intervention on prior authorization success and efficiency at a university medical center. / Cutler, Timothy; She, Yifan; Barca, Jason; Lester, Shawn; Xing, Guibo; Patel, Jigna; Melnikow, Joy.

In: Journal of managed care & specialty pharmacy, Vol. 22, No. 10, 2016, p. 1167-1171.

Research output: Contribution to journalArticle

Cutler, Timothy ; She, Yifan ; Barca, Jason ; Lester, Shawn ; Xing, Guibo ; Patel, Jigna ; Melnikow, Joy. / Impact of pharmacy intervention on prior authorization success and efficiency at a university medical center. In: Journal of managed care & specialty pharmacy. 2016 ; Vol. 22, No. 10. pp. 1167-1171.
@article{f722167fae084d25bc4629ce5d518f8b,
title = "Impact of pharmacy intervention on prior authorization success and efficiency at a university medical center",
abstract = "BACKGROUND: Prior authorizations (PAs) may improve appropriate use of prescription medications. Despite potential savings for health insurance plans, the PA process is time consuming for the ordering provider, pharmacy, and patient. The UC Davis Health System (UCDHS) has created a centralized pharmacy-run clinic PA process. OBJECTIVE: To compare the mean PA processing time between the new centralized clinic and usual care and provide secondary endpoints for PA approval rates, time to prescription fill, time to prescription pick-up, total staff time, and estimated labor costs. METHODS: This is a prospective observational study comparing sequential PA requests at the UCDHS centralized clinic (intervention) and other UCDHS clinics (usual care) between January 1, 2014, and December 31, 2014. The Cochran-Mantel-Haenszel test was used to compare dichotomous outcomes (approval/denial rates) between the 2 groups, controlling for insurance type. A generalized linear model was applied for comparing the continuous outcomes (PA process time, time to first fill, time to pick-up, and cost) with insurance type as covariate. RESULTS: For the intervention group, 47 PAs were evaluated, and 77 PAs were evaluated in the usual care group. The average PA process time was 0.53 days for the intervention group versus 7.02 days for usual care (P < 0.001), and the PA approval rate was 93[{\%}] for the intervention group versus 68[{\%}] for usual care (P < 0.002). The mean time to fill was 2.49 days and 5.52 days for the intervention and usual care clinics, respectively (P = 0.02). The pick-up percentage was 75[{\%}] versus 52[{\%}] for intervention and usual care, respectively (P < 0.001). The intervention clinic spent a significantly lower mean time processing PAs (15 minutes vs. 64 minutes) compared with the usual care clinics (P < 0.001). It is estimated that the mean total labor cost per PA at the intervention clinic was $11.50 compared with $37.50 for the usual care clinics (P < 0.001). CONCLUSIONS: Pharmacy-led interventions in PA processing resulted in a statistically significant benefit in improving time to PA approval, time to first fill, and time to pick-up.",
author = "Timothy Cutler and Yifan She and Jason Barca and Shawn Lester and Guibo Xing and Jigna Patel and Joy Melnikow",
year = "2016",
doi = "10.18553/jmcp.2016.22.10.1167",
language = "English (US)",
volume = "22",
pages = "1167--1171",
journal = "Journal of managed care & specialty pharmacy",
issn = "2376-0540",
publisher = "Academy of Managed Care Pharmacy (AMCP)",
number = "10",

}

TY - JOUR

T1 - Impact of pharmacy intervention on prior authorization success and efficiency at a university medical center

AU - Cutler, Timothy

AU - She, Yifan

AU - Barca, Jason

AU - Lester, Shawn

AU - Xing, Guibo

AU - Patel, Jigna

AU - Melnikow, Joy

PY - 2016

Y1 - 2016

N2 - BACKGROUND: Prior authorizations (PAs) may improve appropriate use of prescription medications. Despite potential savings for health insurance plans, the PA process is time consuming for the ordering provider, pharmacy, and patient. The UC Davis Health System (UCDHS) has created a centralized pharmacy-run clinic PA process. OBJECTIVE: To compare the mean PA processing time between the new centralized clinic and usual care and provide secondary endpoints for PA approval rates, time to prescription fill, time to prescription pick-up, total staff time, and estimated labor costs. METHODS: This is a prospective observational study comparing sequential PA requests at the UCDHS centralized clinic (intervention) and other UCDHS clinics (usual care) between January 1, 2014, and December 31, 2014. The Cochran-Mantel-Haenszel test was used to compare dichotomous outcomes (approval/denial rates) between the 2 groups, controlling for insurance type. A generalized linear model was applied for comparing the continuous outcomes (PA process time, time to first fill, time to pick-up, and cost) with insurance type as covariate. RESULTS: For the intervention group, 47 PAs were evaluated, and 77 PAs were evaluated in the usual care group. The average PA process time was 0.53 days for the intervention group versus 7.02 days for usual care (P < 0.001), and the PA approval rate was 93[%] for the intervention group versus 68[%] for usual care (P < 0.002). The mean time to fill was 2.49 days and 5.52 days for the intervention and usual care clinics, respectively (P = 0.02). The pick-up percentage was 75[%] versus 52[%] for intervention and usual care, respectively (P < 0.001). The intervention clinic spent a significantly lower mean time processing PAs (15 minutes vs. 64 minutes) compared with the usual care clinics (P < 0.001). It is estimated that the mean total labor cost per PA at the intervention clinic was $11.50 compared with $37.50 for the usual care clinics (P < 0.001). CONCLUSIONS: Pharmacy-led interventions in PA processing resulted in a statistically significant benefit in improving time to PA approval, time to first fill, and time to pick-up.

AB - BACKGROUND: Prior authorizations (PAs) may improve appropriate use of prescription medications. Despite potential savings for health insurance plans, the PA process is time consuming for the ordering provider, pharmacy, and patient. The UC Davis Health System (UCDHS) has created a centralized pharmacy-run clinic PA process. OBJECTIVE: To compare the mean PA processing time between the new centralized clinic and usual care and provide secondary endpoints for PA approval rates, time to prescription fill, time to prescription pick-up, total staff time, and estimated labor costs. METHODS: This is a prospective observational study comparing sequential PA requests at the UCDHS centralized clinic (intervention) and other UCDHS clinics (usual care) between January 1, 2014, and December 31, 2014. The Cochran-Mantel-Haenszel test was used to compare dichotomous outcomes (approval/denial rates) between the 2 groups, controlling for insurance type. A generalized linear model was applied for comparing the continuous outcomes (PA process time, time to first fill, time to pick-up, and cost) with insurance type as covariate. RESULTS: For the intervention group, 47 PAs were evaluated, and 77 PAs were evaluated in the usual care group. The average PA process time was 0.53 days for the intervention group versus 7.02 days for usual care (P < 0.001), and the PA approval rate was 93[%] for the intervention group versus 68[%] for usual care (P < 0.002). The mean time to fill was 2.49 days and 5.52 days for the intervention and usual care clinics, respectively (P = 0.02). The pick-up percentage was 75[%] versus 52[%] for intervention and usual care, respectively (P < 0.001). The intervention clinic spent a significantly lower mean time processing PAs (15 minutes vs. 64 minutes) compared with the usual care clinics (P < 0.001). It is estimated that the mean total labor cost per PA at the intervention clinic was $11.50 compared with $37.50 for the usual care clinics (P < 0.001). CONCLUSIONS: Pharmacy-led interventions in PA processing resulted in a statistically significant benefit in improving time to PA approval, time to first fill, and time to pick-up.

UR - http://www.scopus.com/inward/record.url?scp=84990985808&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84990985808&partnerID=8YFLogxK

U2 - 10.18553/jmcp.2016.22.10.1167

DO - 10.18553/jmcp.2016.22.10.1167

M3 - Article

C2 - 27668565

AN - SCOPUS:84990985808

VL - 22

SP - 1167

EP - 1171

JO - Journal of managed care & specialty pharmacy

JF - Journal of managed care & specialty pharmacy

SN - 2376-0540

IS - 10

ER -