Don’t you hate prior authorization?

I’ve always disliked prior authorization, the process by which a managed care plan requires a physician to get permission before writing a prescription for a drug, even when it’s on formulary. So when I got a call from a Managed Healthcare Executive reporter asking about “innovations in prior authorization,” I talked about ways to eliminate the need for prior authorization in the first place.

The article (Prior authorization process lightened by electronic information) does a good job laying out the rationale for prior auth in an age of expensive meds and cost pressures. But I was also happy to see the last column devoted to my suggestions of alternatives:

  • Real-time decision support tools (like Safe-Med) that include clinical and business rules
  • Comprehensive evidence based clinical information resources (like UpToDate)
  • e-prescribing, to make the prior auth process less painful and more automated when it needs to occur
August 23, 2005

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