Refocusing medication prior authorisation on its intended purpose

JAMA

3 February 2020 - During the 1980s, prospective utilisation review programs deployed by US health plans focused on screening the appropriateness of hospital admissions and high-cost procedures. 

As prescription drug coverage became more widespread and spending on pharmaceuticals increased, commercial and public insurers expanded utilisation management to include medication prior authorisation, quantity and dosage limits, and step therapy requirements. 

Applied in concert with restricted formularies and tiered patient cost sharing, these measures were initially directed during the 1990s and early 2000s at a narrow set of newer, high-cost drugs that insurers judged to offer limited benefit or higher risk over existing, less expensive alternatives.

However, prior authorisation has expanded during the last decade to involve larger shares of formularies in commercial and government plans.

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Michael Wonder

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Michael Wonder