Pharmacy-Led Prior Authorization Team Increased Approval Efficiency

After the implementation of a pharmacy-led prior authorization (PA) team, there was an increased rate of prior authorization approvals and a decreased turnaround time, according to a study presented at the American Society of Health-System Pharmacist’s 2021 Midyear conference. The study investigators found that redistribution and standardization of PA processes within health systems allowed pharmacy technicians to reduce the burden on staff members from other roles.

The results of the study showed the approval rate for PAs had increased from 61.5%, from the previous year, to 70.5% in 9 months, following the implementation of a PA team. The turnaround time also decreased from the previous year to the following 9 months after implementation of the PA team.

The staff involved provided positive feedback and satisfaction with the new service, while the members of the PA team also provided positive feedback about their advanced technician role. Additionally, an improved level of PA efficiency was identified as a result of the PA team implementation; prior to the PA team development, the health system had reports of PAs causing barriers to medication access as well as feedback from staff about the challenge of processing PAs.

During the investigation, data was collected and evaluated by the authors for a more extensive understanding of the current state of operations. Software integrations and enhancements of electronic health records were additionally assessed.

A business plan was then formulated and approved in order to establish a centralized team to manage PAs for the health system staffed by pharmacy technicians and managed by the pharmacy. Ongoing process evaluations for continuous improvement occurred during the implementation period. Furthermore, investigators provided staff education in order to support and facilitate appropriate processes and workflows.

Reference

Peters, M. (Management Case Study) Enhancing Medication Access Through Implementation of a Centralized Pharmacy Prior Authorization (PA) Team. ASHP Midyear 2021. Accessed December 6, 2021. https://www.eventscribe.net/2021/midyear/agenda.asp?pfp=OnDemandSchedule