Episode 3: How Do Prior Authorization and Cost Impact Patient Care?



Ray Tancredi, RPh, MBA, Vice President Specialty Pharmacy Development, Walgreens; Cheryl Allen, BS Pharm, MBA, Vice President, Industry Relations, Diplomat Pharmacy Inc.; Nicholas Karalis, RPh, Elwyn Pharmacy Group; Stacey Ness, PharmD, RPh*, Director, Specialty Clinical Services, Managed Healthcare Associates; Renee Rayburg, RPh, Senior Director, Clinical Consulting, Artemetrx

Domestic spending on specialty medications is projected to increase by 67% in 2015, which will lead to increased out-of-pocket spending for patients who will increasingly need to seek outside funding sources to pay for these treatments, the panelists agreed. With these increased costs, Allen noted, the use of prior authorization will also grow.

Rayburg added that prior authorization is utilized as a tool for payers to evaluate the appropriate use of medications, but should not be seen as a tool to set up barriers. Prior authorization, she concluded, should be used to identify the right patients to receive the right drug for the right duration.

*The views expressed are those of the individual alone and not of Managed Health Care Associates, Inc.

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