A physician-friendly alternative to prior authorization for prescription drugs.
OBJECTIVE
To determine if the instant approval (IA) process differs from the traditional prior authorization (PA) process in preferred drug channeling, resultant gaps in therapy, and provider dissatisfaction.


METHODS
An interrupted time series analysis using pharmacy claims and a retrospective cohort study.


METHODS
The study assessed changes in preferred drug use and subsequent cost reductions. A retrospective cohort study determined if the IA process produced fewer gaps in therapy than the PA process. Provider acceptance of the IA process was assessed using a brief survey of 240 randomly selected primary care practices.


RESULTS
Market share for preferred proton pump inhibitors quadrupled from a range of 17.6% to 19.3% at baseline to 76% in the first month after implementation of the new IA policy. Most practices (81.1%) reported reduced administrative burden with the IA process. The median gaps between medication fills for patients using IA were approximately one-half those of patients using PA (P <.001) and were one-fourth in a subset of highly adherent, regularly filling patients (P <.001).


CONCLUSIONS
Instant approval may be more patient friendly and prescriber friendly than PA as assessed by a proxy measure for access (gap in therapy) and physician-reported acceptance. Despite its ease of use, IA does not seem to reduce switching to preferred drugs.
Wegner
Steven E
SE
AccessCare, 3500 Gateway Centre Blvd, Ste 130, Morrisville, NC 27560, USA. sew@ ncaccesscare.org
Trygstad
Troy K
TK
Dobson
L Allen
LA
Lawrence
William W
WW
Steiner
Beat D
BD
D015331:Cohort Studies; D003258:Consumer Behavior; D003363:Cost Control; D020793:Gatekeeping; D006801:Humans; D008329:Managed Care Programs; D009657:North Carolina; D010820:Physicians; D055553:Prescription Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies
D055553:Prescription Drugs