Desai, Sheena Lo, Kelly Nambudiri, Vinod E Villa-Ruiz, Camila LaChance, Avery Vleugels, Ruth Ann
Published in
Archives of dermatological research
Alopecia areata (AA) is a psychologically distressing disorder for which few reliable treatments exist. Although oral tofacitinib has demonstrated efficacy in treating AA, it is not approved by the Food and Drug Administration (FDA) for this indication. To investigate and identify the challenges associated with securing insurance approval for oral ...
Bachhuber, Marcus A.
Published in
Addiction Science & Clinical Practice
The process by which state Medicaid programs develop their preferred drug lists, and determine which medications require prior authorization, is opaque to many clinicians. This process is a synthesis of cost and clinical information. For cost, the federal Medicaid Drug Rebate Program establishes mandatory rebates that pharmaceutical manufacturers m...
Lee, Victoria Berland, Todd Jacobowitz, Glenn Rockman, Caron Sadek, Mikel Barfield, Michael Cayne, Neal Maldonado, Thomas S
Published in
Journal of vascular surgery. Venous and lymphatic disorders
Prior authorization (PA) is a process used by payers for safety and cost savings purposes, but it has received criticism for being time-consuming and costly because of administrative burden. Our study evaluated efficacy of PA applied to in-office lower extremity superficial venous procedures. All in-office lower extremity venous procedures schedule...
Powell, Adam C Lugo, Christopher T Wang, Yan Smith, Gary L Long, James W Deshmukh, Uday U Robinson, Jeffrey D
Published in
Academic radiology
Practice guidelines suggest most patients should wait at least 28 days from the onset of low back pain before receiving imaging. This study evaluates a nondenial prior authorization program's performance in modifying lower back imaging orders. Ordering physicians were asked by a consulting physician to modify any order that did not meet guidelines ...
Knickelbine, Thomas Jia, Lori White, Susan K Garberich, Ross F Oberembt, Sandra J Wills, Samantha Miedema, Michael D Brilakis, Emmanouil S
Published in
Journal of clinical lipidology
Despite patient and provider interest, the use of PCSK9i therapy remains limited in clinical practice. High annual listed prices have created intense payer scrutiny and frequent health plan denials, with national approval rates in the range of 30% to 40%. Our goal was to validate the strategies for increasing PCSK9i approval rates and to present a ...
Brown, Gary C. Brown, Melissa M.
Published in
Current Ophthalmology Reports
Purpose of ReviewThe goal herein is to discuss preauthorization for U.S. diagnostic and therapeutic interventions and ascertain the benefits and adverse events associated with it. Preauthorization is the process of requiring a physician to obtain permission from a healthcare insurer to perform a diagnostic or therapeutic procedure.Recent FindingsPr...
Melvin, Kelly E Hart, Joseph C Sorvig, Richard D
Published in
Psychiatric services (Washington, D.C.)
Implementation of a second-generation antipsychotic PA program for children under age 18 resulted in a significant decrease in the prescribing rate for this class of medication, without sustained compensatory prescribing of other psychotropic classes.
Stacey, Brett R. Liss, Jonathan Behar, Regina Sadosky, Alesia Parsons, Bruce Masters, Elizabeth T. Hlavacek, Patrick
Published in
BMC Health Services Research
BackgroundFormularies often employ restriction policies to reduce pharmacy costs. Pregabalin, an alpha-2-delta ligand, is approved for treatment of fibromyalgia (FM); neuropathic pain (NeP) due to postherpetic neuralgia (PHN), diabetic peripheral neuropathy (pDPN), spinal cord injury; and as adjunct therapy for partial onset seizures. Pregabalin is...
Pakyz, Amy L Moczygemba, Leticia R VanderWielen, Lynn M Edmond, Michael B Stevens, Michael P Kuzel, Anton J
Published in
American journal of infection control
Many hospitals have implemented antimicrobial stewardship programs (ASPs) and have included in their programs strategies such as prior authorization and audit and feedback. However there are few data concerning the facilitators and barriers that ASPs face when implementing their strategies. We conducted a qualitative study to discern factors that l...
Ben-Joseph, Rami Chen, Chi-Chang De, Ajita P Wade, Rolin L Shah, Dhvani
Published in
Journal of medical economics
To evaluate the impact of increased access restrictions to branded oxycodone hydrochloride extended-release tablets (oxycodone HCl ER), on healthcare utilization and costs in patients using extended-release and long-acting opioids (ER/LA opioids) from the health plan perspective during the period from 1/1/2009 to 6/30/2012. This retrospective cohor...
