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Clin Infect Dis. 2010 Sep 15;51(6):718-24. doi: 10.1086/655890.

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

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Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, AL 35294-2050, USA.


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.

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