Reducing the Burden of Medication Prior Authorizations

Medication prior authorizations (PAs) are a vexing part of practice for family medicine physicians and their office staff. PAs are often not based on the most recent clinical guidelines or scientific evidence and have increasingly become a barrier to timely patient-centered care.¹ PAs are equally exasperating for patients, who anticipate that the prescriptions you write will be filled without significant delay or inordinate expense. There is no clear evidence that PA requirements improve quality or patient-centered outcomes. PA has been shown to decrease the use of targeted therapies and the costs associated with them;^2,3 however, that does not translate to improved clinical outcomes. Prescribing decisions should be guided by the physician's judgment, patient understanding, and clinical evidence, rather than driven by an insurance algorithm.

Although multiple facets of patient care (medications, diagnostic imaging, durable medical equipment, surgical procedures, and inpatient hospital care) can trigger the PA process, this article will deal only with medication PAs. We will describe several steps family physicians can take to reduce medication PAs.

Prescribing generic medications not only helps you avoid PA but also ensures that your patients secure the lowest copayment when they fill their prescriptions. Choose a generic medication within the same class as the one triggering the PA to eliminate the process and secure a quick victory for your team. The cost savings of generics can accumulate, especially for patients on multiple medications. If patients insist on a branded medication and you think it may not be medically necessary, explain that the time spent on PA detracts from the time available for direct care, and the use of generics reduces their copay and overall costs. When branded medications are necessary, having documented evidence of previous attempts to use generic alternatives for the patient is crucial.