Study Results from Genomic Medicine Institute Broaden Understanding of Health-System Pharmacy (Medications Requiring Prior Authorization Across Health Insurance Plans)

2020 SEP 30 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- Current study results on Drugs and Therapies - Health-System Pharmacy have been published. According to news originating from Danville, Pennsylvania, by NewsRx correspondents, research stated, “To determine the amount of variation in numbers and types of medications requiring prior authorization (PA) by insurance plan and type. Most health insurance companies require PA for medications to ensure safe and effective use and contain costs.”

Financial support for this research came from Pennsylvania Department of Health.

Our news journalists obtained a quote from the research from Genomic Medicine Institute, “We generated 4 lists of medications that required PA during 2017 for commercial, marketplace, Medicaid, and Medicare plans. We aggregated medications according to the generic medication name equivalent using codes and medication names. We compared these medications to assess how many of the medications required PA by 1, 2, 3, or all 4 of the insurance plans. We counted all prescription orders written for a patient age 18 years or older with health plan insurance during 2017 for any of the medications that appeared on the health plan’s PA lists by querying the electronic health record. PA was required for 600 unique medications in 2017 across the 4 plans. Of 691,457 prescription orders written for 114,159 members, 31,631 (5%) were written for 1 of the 600 medications that required PA by at least 1 insurance plan. There were 12,540 medication orders (written for 6,642 members) that potentially required PA. The marketplace plan required PA for the greatest number of medications (440), followed by the Medicare (272), commercial (271), and Medicaid (72) plans. The most commonly prescribed classes of medications for which PA was required by at least 1 plan were antihyperlipidemics (22% of orders potentially requiring PA), narcotic analgesics (13%), hypnotics (12%), antidiabetic medications (9%), and antidepressants (9%). For only 25% of medications (151 of 600) was PA required by at least 3 plans, and for only 5% (32 of 600) was PA required by all 4 insurance types.”

According to the news editors, the research concluded: “Medications requiring PA can differ within a single health insurance company, but this variation may be unavoidable due to external factors.”

For more information on this research see: Medications Requiring Prior Authorization Across Health Insurance Plans. American Journal of Health-System Pharmacy, 2020;77(8):644-648. American Journal of Health-System Pharmacy can be contacted at: Oxford Univ Press Inc, Journals Dept, 2001 Evans Rd, Cary, NC 27513, USA.

The news correspondents report that additional information may be obtained from Laney K. Jones, Geisinger, Genomic Medicine Institute, Danville, PA 17822, United States. Additional authors for this research include Ilene G. Ladd, Michael R. Gionfriddo, Christina Gregor, Jove Graham and Michael A. Evans.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1093/ajhp/zxaa031. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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