Use of a specialty pharmacy to take over the management of prior authorization (PA) requests for a dermatology practice significantly reduced the time to a decision and also decreased the time it took to fill the medication, according to a recent study.
Specialty medications represent the largest category of drug spending but are used by the fewest number of patients. Payers increasingly require PA before a patient is allowed to begin a reimbursed therapy, and the time and clinical documentation required to be submitted to complete these requests are one of the top complaints of specialists, including dermatologists, rheumatologists, and others.
A recent study, published in the Journal of the American Pharmacists Association, examined whether a community-based specialty care pharmacy could speed up the process (whether it led to an approval or a denial) for dermatology practices. The study also sought to compare the timeliness of PA (time to approval and time to first medication fill) between a community-based specialty pharmacy and a dermatology practice.
Researchers used data from Realo Specialty Care, a community-based independent specialty pharmacy that is part of a larger group of 18 independent pharmacies in eastern North Carolina. The specialty pharmacy, which operates in 10 states, began in 2015 to provide care for patients with chronic conditions who are using specialty medications.
This study conducted a retrospective analysis of pharmacy dispensing system data for patients using medications for atopic dermatitis, plaque psoriasis, and hidradenitis suppurativa.
PAs are traditionally completed by a provider’s practice, and data are documented within the pharmacy system as a PA task. Data included documented PA tasks within the pharmacy system for dermatology prescriptions for patients aged 18 years or older between January 1, 2017, and June 30, 2019.
PA tasks included initial receipt of the prescription, the PA decision, and the PA decision date; prescription data confirmed when the drug was first filled.
Results showed a statistically significant difference in the speed at which PA decisions were made.
PA requests completed by the provider’s office took, on average, almost 3 weeks, or an average of 20.9 days (P < .001). The specialty pharmacy, however, completed 677 PA tasks with a mean time to PA decision of 1.9 days. Compared with the 677 PA tasks completed by the specialty pharmacy, the provider’s office completed 66 eligible PA requests.
The pharmacy demonstrated a mean time to first fill of 6.6 days; the provider’s office averaged 16.2 days (P < .001).
Moreover, the specialty pharmacy received approval for 93% of the PAs completed, compared with 76% by the dermatology office.
One study limitation is not knowing how the dermatology practice submitted its PA requests (paper vs electronic); the specialty pharmacy primarily uses electronic PAs.
“The study suggests that pharmacist involvement in the PA process can be beneficial to patient medication access,” wrote the authors, who included both pharmacy executives from Realo as well as faculty from the University of North Carolina at Chapel Hill. “Further study would be necessary to determine whether there is a clinical impact associated with the expedited medication access for patients.”
Hecht B, Frye C, Holland W, Holland CR, Rhodes LA, Marciniak MW. Analysis of prior authorization success and timeliness at a community-based specialty care pharmacy. J Am Pharm Assoc Am Pharm Assoc. Published online January 5, 2021. doi: 10.1016/j.japh.2021.01.001