Uncompensated medical provider costs associated with prior authorization for prescription medications in an HIV clinic
Department of Quantitative Health Sciences
Alabama; Ambulatory Care; Anti-HIV Agents; Female; HIV Infections; *Health Care Costs; *Health Personnel; Health Services Administration; Humans; Male; Prescriptions
Bioinformatics | Biostatistics | Epidemiology | Health Services Research
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.
DOI of Published Version
Clin Infect Dis. 2010 Sep 15;51(6):718-24. Link to article on publisher's site
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Raper, James L.; Willig, James H.; Lin, Hui-Yi; Allison, Jeroan J.; Broner, M. Bennet; Mugavero, Michael J.; and Saag, Kenneth G., "Uncompensated medical provider costs associated with prior authorization for prescription medications in an HIV clinic" (2010). Quantitative Health Sciences Publications and Presentations. 932.