Uncompensated medical provider costs associated with prior authorization for prescription medications in an HIV clinic.
Although prior authorization (PA) for prescription medications is widely employed for cost-containment for third-party insurers, it is a frustrating aspect of outpatient clinical care that imposes uncompensated costs to medical providers. To characterize these costs, we monitored the PA-associated administrative and operational process at the University of Alabama at Birmingham 1917 HIV Clinic over a 2-year period. A total of 288 PAs were processed with a mean (+/- standard deviation [SD]) of 3.1+/-5.8 days delay in the patient's access to medication. A mean (+/-SD) of 26.8+/-18.4 min was spent by the nurse practitioner and 6.5+/-2.9 min was spent by a clerk per PA. Nearly three-quarters (73%) of PAs were approved, 18% were denied, and 10% were voided. The mean (+/-SD) pages of paperwork was 5.8+/-6.5. The overall cost was $41.60 per PA. Although evidence supports that PA reduces third-party expenditures, it significantly delays medication accessibility for patients and imposes high costs that negatively impact operating margins for health care providers.
Raper
James L
JL
Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, AL 35294-2050, USA. jimraper@uab.edu
Willig
James H
JH
Lin
Hui-Yi
HY
Allison
Jeroan J
JJ
Broner
M Bennet
MB
Mugavero
Michael J
MJ
Saag
Michael S
MS
D000407:Alabama; D000553:Ambulatory Care; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D017048:Health Care Costs; D006282:Health Personnel; D006298:Health Services Administration / Q000191:economics*; D006801:Humans; D008297:Male; D055656:Prescriptions / Q000191:economics*
D019380:Anti-HIV Agents