Journal Article

Uncompensated Medical Provider Costs Associated with Prior Authorization for Prescription Medications in an HIV Clinic

Ellie J. C. Goldstein, James L. Raper, James H. Willig, Hui-Yi Lin, Jeroan J. Allison, M. Bennet Broner, Michael J. Mugavero and Michael S. Saag

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 51, issue 6, pages 718-724
Published in print September 2010 | ISSN: 1058-4838
Published online September 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/655890
Uncompensated Medical Provider Costs Associated with Prior Authorization for Prescription Medications in an HIV Clinic

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Although prior authorization (PA) for prescription medications is widely employed for cost-containment for third-party insurers, it is a frustrating aspect of outpatient clinical care that imposes uncompensated costs to medical providers. To characterize these costs, we monitored the PA-associated administrative and operational process at the University of Alabama at Birmingham 1917 HIV Clinic over a 2-year period. A total of 288 PAs were processed with a mean (± standard deviation [SD]) of 3.1 ± 5.8 days delay in the patient's access to medication. A mean (±SD) of 26.8 ± 18.4 min was spent by the nurse practitioner and 6.5 ± 2.9 min was spent by a clerk per PA. Nearly three-quarters (73%) of PAs were approved, 18% were denied, and 10% were voided. The mean (±SD) pages of paperwork was 5.8 ± 6.5. The overall cost was $41.60 per PA. Although evidence supports that PA reduces third-party expenditures, it significantly delays medication accessibility for patients and imposes high costs that negatively impact operating margins for health care providers.

Journal Article.  3043 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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