Prior Authorization Programs: A Critical Review of the Literature

Abstract

OBJECTIVE: Though prior authorization (PA) programs are widely used in the managed care pharmacy environment, some stakeholders question whether these programs are effective. The objective of this article is to critically examine the effect of PA programs on health-related outcomes. DATA SOURCES: A computer-aided search of the literature was conducted using several online databases to find studies that have evaluated PA programs. Other sources of information used were reference lists, authors of previous studies, and meeting abstracts. STUDY SELECTION: In order for a study to be included in our analysis, it had to (1) appear in the peer-reviewed literature and (2) investigate the effects of a PA program on specified drugs. We excluded papers that studied the effectiveness of formulary systems, of which PA may be a component. DATA EXTRACTION: From each study evaluated, we extracted data related to the study design and to the effect of the PA program on economic, clinical, and humanistic outcomes. DATA SYNTHESIS: Six studies met our criteria. Overall, PA programs appear to be effective at reducing drug-related costs. There is some evidence that they reduce non drug-related costs but little evidence that they have a positive impact on clinical or humanistic outcomes. None of the studies had a randomized, controlled design; most of the studies had severe methodological limitations. CONCLUSION: Rigorously designed studies are urgently needed in order to evaluate the effects of PA on health related outcomes.

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