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Uncompensated medical provider costs associated with prior authorization for prescription medications in an HIV clinic.

Authors
  • Raper, James L
  • Willig, James H
  • Lin, Hui-Yi
  • Allison, Jeroan J
  • Broner, M Bennet
  • Mugavero, Michael J
  • Saag, Michael S
Type
Published Article
Journal
Clinical Infectious Diseases
Publisher
Oxford University Press
Publication Date
Sep 15, 2010
Volume
51
Issue
6
Pages
718–724
Identifiers
DOI: 10.1086/655890
PMID: 20695800
Source
Medline
License
Unknown

Abstract

Although prior authorization (PA) for prescription medications is widely employed for cost-containment for third-party insurers, it is a frustrating aspect of outpatient clinical care that imposes uncompensated costs to medical providers. To characterize these costs, we monitored the PA-associated administrative and operational process at the University of Alabama at Birmingham 1917 HIV Clinic over a 2-year period. A total of 288 PAs were processed with a mean (+/- standard deviation [SD]) of 3.1+/-5.8 days delay in the patient's access to medication. A mean (+/-SD) of 26.8+/-18.4 min was spent by the nurse practitioner and 6.5+/-2.9 min was spent by a clerk per PA. Nearly three-quarters (73%) of PAs were approved, 18% were denied, and 10% were voided. The mean (+/-SD) pages of paperwork was 5.8+/-6.5. The overall cost was $41.60 per PA. Although evidence supports that PA reduces third-party expenditures, it significantly delays medication accessibility for patients and imposes high costs that negatively impact operating margins for health care providers.

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