Prior Authorization and Associated Delays and Denials of Branded Medication Dispensation

For branded medication prescriptions that are initially rejected by the prior authorization (PA) review, how many are eventually approved and how much time does the process require?In this cross-sectional study of 205 896 medication dispensations initially rejected, 35% were processed in 1 day and 54% were eventually approved. Prescriptions with multiple PA reviews, additional rejection reasons, and refills were delayed and patients with Medicaid coverage or multiple disease conditions experienced fewer prescription approvals.When filling a branded medication that was initially rejected by PA, most patients experienced treatment delays and/or eventual denials, outcomes that were associated with claim adjudication complexity, prescription type, and patient characteristics.

Corresponding Author: Yang Wang, PhD, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 1812 Ashland Ave, Baltimore, MD 21205 (ywang406@jhu.edu).

Link to the article in your story

We encourage you to link out to this article in your story using the link below. It includes an access token that will give free access to the article for your readers up to one year after publication. (The link will be live after the article publishes and embargo is lifted.)

Please see the article for additional information, including full author list, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

Need more information? Contact us.