Uncompensated medical provider costs associated with prior authorization for prescription medications in an HIV clinic.

Academic Article

Abstract

  • 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.
  • Published In

    Keywords

  • Alabama, Ambulatory Care, Anti-HIV Agents, Female, HIV Infections, Health Care Costs, Health Personnel, Health Services Administration, Humans, Male, Prescriptions
  • Digital Object Identifier (doi)

    Author List

  • Raper JL; Willig JH; Lin H-Y; Allison JJ; Broner MB; Mugavero MJ; Saag MS
  • Start Page

  • 718
  • End Page

  • 724
  • Volume

  • 51
  • Issue

  • 6