Date of Publication

2020

Project Team

Rosemary Dale, Alison Bovee

Abstract

Title and Abstract

  1. 1. Title

Optimizing Drug Prior Authorization Procedures for Primary Care

  1. 2. Abstract

Background:

Medication prior authorization (MPA) is a cost containment strategy utilized by health plans. The payer, or health plan requires providers to obtain prior approval for plan coverage of a drug prescription. The list of drugs requiring MPA varies among health plans and is subject to frequent change. From 2007 to 2013 Medicare Part D increased MPA requirements by 38 percent (Hoadley, Summer, Hargrave, & Cubanski, 2014).

Methods:

Pre and post interventional surveys of primary care staff were used to gather descriptions of current MPA processes and staff feedback about the interventional tool, which was a smartphrase or dotphrase template integrated into the EHR to optimize MPA documentation.

Results:

45.5% of the staff completed both the pre and post surveys. Forty per cent of staff completing the post survey who used the smartphrase, described the intervention as, “great.” The remaining staff did not have the opportunity to use the smartphrase, including one participant not planning on using the smartphrase due to it requiring additional documentation.

Conclusions:

A simple intervention such as a smartphrase, incorporated into the workflow, can optimize the MPA process in a primary care office by providing a standardized EHR documentation feature for crucial prior authorization information. While the smartphrase potentially decreases MPA denials and non-provider staff time, it potentially increases documentation time for providers.

Keywords: prior authorization, primary care, smartphrase, dotphrase, medication, drug, workflow intervention.

Document Type

Project

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