Uncompensated medical provider costs associated with prior authorization for prescription medications in an HIV clinic

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date


Document Type



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

Journal/Book/Conference Title

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

PubMed ID


Related Resources

Link to Article in PubMed