title: Prior authorization to improve testing of glycosylated hemoglobin in a managed care setting.
abstract: OBJECTIVE
  To ascertain whether revocation of a prior authorization (PA) requirement by the Leumit Health Fund of Israel resulted in inferior rates of glycosylated hemoglobin (A1C) testing among new users of expensive diabetes medications.
  
  
  METHODS
  Electronic patient record (EPR) database study.
  
  
  METHODS
  Data on new users of the target drugs and on A1C testing in these patients were extracted from EPR databases for the 6-month period after the revocation. The proportion (95% confidence interval [CI]) of patients who obtained at least 1 A1C test during the 4 months before initiation of treatment was calculated. The data were stratified by month to detect possible trends in rates of testing during the period after the policy change.
  
  
  RESULTS
  After the PA requirement was rescinded, A1C testing among incident users of the target drugs dropped from 100% during the PA period to rates ranging from 85.6% (95% CI, 79.7%-91.5%) to 94.4% (95% CI, 90.8%-97.9%). Statistically significant variance in monthly rates of testing was not observed.
  
  
  CONCLUSIONS
  Prior authorization has been successfully implemented in the managed care setting studied to obtain 100% performance of a laboratory test necessary to monitor drug therapy outcomes in patients with diabetes mellitus. When PA is implemented as a quality assurance strategy, its revocation should be accompanied by continuing education efforts designed to maintain optimal adherence to recommendations for appropriate care.
authors.affiliation: Medical Division, Leumit Health Fund, PO Box 20083, Tel Aviv 64738, Israel. nkahan@leumit.co.il
authors.forename: Natan R
authors.initials: NR
authors.lastname: Kahan
authors.forename: Dan-Andrei
authors.initials: DA
authors.lastname: Waitman
authors.forename: Shimon
authors.initials: S
authors.lastname: Blackman
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Vardy
mesh_terms: D016001:Confidence Intervals; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D019458:Insurance Coverage; D007557:Israel; D008329:Managed Care Programs; D016347:Medical Records Systems, Computerized; D055118:Medication Adherence; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents