Evaluating a Collaborative Approach to Improve Prior Authorization Efficiency in the Treatment of Hepatitis C Virus.

Qual Manag Health Care

University of Maryland School of Pharmacy, Baltimore (Dr Dunn); Ambulatory Pharmacy, University of Maryland Medical Center, Baltimore (Dr Vranek); Department of Pharmacy Practice, University of Maryland School of Pharmacy, Baltimore (Drs Hynicka and Mattingly II); and Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore (Ms Gripshover and Dr Potosky).

Published: April 2018

Objective: A team-based approach to obtaining prior authorization approval was implemented utilizing a specialty pharmacy, a clinic-based pharmacy technician specialist, and a registered nurse to work with providers to obtain approval for medications for hepatitis C virus (HCV) infection. The objective of this study was to evaluate the time to approval for prescribed treatment of HCV infection.

Methods: A retrospective observational study was conducted including patients treated for HCV infection by clinic providers who received at least 1 oral direct-acting antiviral HCV medication. Patients were divided into 2 groups, based on whether they were treated before or after the implementation of the team-based approach. Student t tests were used to compare average wait times before and after the intervention.

Results: The sample included 180 patients, 68 treated before the intervention and 112 patients who initiated therapy after. All patients sampled required prior authorization approval by a third-party payer to begin therapy. There was a statistically significant reduction (P = .02) in average wait time in the postintervention group (15.6 ± 12.1 days) once adjusted using dates of approval.

Conclusions: Pharmacy collaboration may provide increases in efficiency in provider prior authorization practices and reduced wait time for patients to begin treatment.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5499965PMC
http://dx.doi.org/10.1097/QMH.0000000000000137DOI Listing

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