A Physician-Friendly Alternative to Prior Authorization for Prescription Drugs

Objectives: 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. Study Design: 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. (Am J Manag Care. 2009; 15(12): e115-e122)