Medication Therapy Management
Pharmacist-Initiated Prior Authorization Process to Improve Patient Care in a Psychiatric Acute Care Hospital
Journal of Pharmacy Practice 2015, Vol. 28(1) 31-34 ª The Author(s) 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0897190014562383 jpp.sagepub.com
Shari N. Allen, PharmD, BCPP1, and Mebanga Ojong-Salako, PharmD2
Abstract A prior authorization (PA) is a requirement implemented by managed care organizations to help provide medications to consumers in a cost-effective manner. The PA process may be seen as a barrier by prescribers, pharmacists, pharmaceutical companies, and consumers. The lack of a standardized PA process, implemented prior to a patient’s discharge from a health care facility, may increase nonadherence to inpatient prescribed medications. Pharmacists and other health care professionals can implement a PA process specific to their institution. This article describes a pharmacist-initiated PA process implemented at an acute care psychiatric hospital. This process was initiated secondary to a need for a standardized process at the facility. To date, the process has been seen as a valuable aspect to patient care. Plans to expand this process include collecting data with regards to adherence and readmissions as well as applying for a grant to help develop a program to automate the PA program at this facility. Keywords prior authorization, pharmacist, managed care organization, adherence
Prior Authorization Programs A prior authorization (PA) program is a tool implemented by managed care organizations (MCOs) designed to permit plan members to receive medications that are safe and effective for their condition in a cost-effective manner. PA requirements for MCOs may differ from plan to plan and state to state and may be based on therapeutic rationale, clinical needs, and cost. PA guidelines often encourage the use of generically available medications, the use of alternative less costly drugs used for the same indication, the use of a step therapy approach to care, restrictions on clinical situations in which expensive medications may be used, or restriction of the dose or quantity (ie, quantity limits) of a medication while still maintaining a therapeutic dosage range.1,2 In order to qualify for reimbursement from a drug requiring a PA, prescribers must obtain preapproval prior to prescribing the medication.3 The PA process can be used by prescribers and patients to request coverage for the more costly medication that is not included on the formulary. The prescriber will provide more information as to why he or she prefers a particular medication. The MCO will review patient characteristics, diagnosis, and prescription history. This information is then utilized by the MCO to determine coverage on a case-by-case basis.4-6 Drugs that require a PA will not be approved for payment until conditions for approval of the drug are met. The PA process can be used to enforce a step therapy approach to care.1 A step therapy approach to care ensures
that an established cost-effective drug therapy is used prior to progressing to other therapies.5 A step therapy approach to care requires the use of a clinically recognized first-line drug before approval of another more expensive agent.5 Step therapy approach to care consists of reviewing a patient’s past prescription claims history to qualify a patient for coverage at the point of sale. If the patient has a claim history of utilizing a first-line drug, he or she may qualify for coverage of a second-line agent without the need for the prescriber to submit a PA request.5 A PA can be used to prevent inappropriate use of medications. Some MCOs may limit coverage to Food and Drug Administration-approved conditions and requires a PA for off-label uses. A PA request for an off-label use requires documentation from the prescriber to confirm the use for which the product was prescribed. In the PA request, the prescriber may have to provide evidence supporting the unapproved use.5 In addition, MCOs may require PAs for select
1 Philadelphia College of Osteopathic Medicine School of Pharmacy, Suwanee, GA, USA 2 PGY-1 Resident VA Texas Valley Coastal Bend Health Care System, Harlingen, TX, USA
Corresponding Author: Shari N. Allen, Philadelphia College of Osteopathic Medicine School of Pharmacy, 625 Old Peachtree Road NW, Suwanee, GA 30024, USA. Email: [email protected]
Downloaded from jpp.sagepub.com at GEORGIAN COURT UNIV on February 24, 2015
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medications such as chemotherapy agents. The PA is intended to ensure that the selected medication is clinically necessary and prescribed by the proper specialty expert before approving the medication.5 Prescribers, pharmacists, pharmaceutical companies, and consumers may be impacted negatively and/or have negative views of PA programs. Pharmaceutical companies view PA programs as a barrier to getting their drugs on the market.3 Likewise, consumers may view PA programs as a barrier to accessing their medications, which can lead to dissatisfaction with their health care providers, insurance companies, or pharmacy.3,4 Some prescribers view PA paperwork as too time consuming and thus can lead to not prescribing a medication that the physician feels would be most beneficial to a patient.3 Community pharmacists also view PA programs and requirements as a time-consuming burden that is impeding their patients from getting access to their medications.3 These negative views on PA programs often stem from the lack of health care settings having an established standardized PA process. A lack of a standardized PA process has caused some prescribers to view PA programs as a barrier to patients getting their medications and thus interfering with adherence. Implementing a well-designed evidence-based PA process is time effective, optimizes patient care, and reduces medication error and waste.3
Pharmacist-Initiated PA Process Rationale A pharmacist-initiated prior authorization process (PIPAP) was implemented at a 54-bed not-for-profit, acute care psychiatric hospital. The program was initiated in order to address the lack of a formal PA process in the facility. Previous to the PIPAP, PAs were being completed by therapy staff and case management. Barriers encountered prior to the PIPAP included time constraints to complete PA forms, a lack of knowledge of the PA criteria required by MCOs, and unfamiliarity with MCO’s formularies leading to a lack of identification of PA needs prior to a patient’s discharge. These barriers may result in delayed outpatient adherence of inpatient-prescribed medications. Nonadherence to mental health treatment is related to poor outcomes.7 Ascher-Svanum et al completed a multisite, 3-year, prospective, naturalistic study to determine the relationship between medication adherence and long-term functional outcomes in the treatment of schizophrenia. In this study, nonadherence to treatment with antipsychotics in patients with schizophrenia was associated with poorer functional outcomes one of which included a greater risk of psychiatric hospitalizations. Nonadherence in the first year was a predictor for poorer outcomes in the next 2 years.8 Similar results of poorer outcomes have been found in nonadherence to medications used to treat medical conditions such as diabetes.9 The objectives of the PIPAP at our facility are to establish a formal process for identifying PA needs of admitted patients and improve patient’s access to their psychiatric
Table 1. Pharmacist-Initiated Prior Authorization Process (PIPAP). Steps in the PIPAP
Explanation
Medication formulary placed in patient chart
A patient-specific medication (psychiatric medications) formulary is placed in the chart as a reference for prescribers The formulary also serves to help the pharmacist and others identify barriers to acquiring the prescribed medication prior to a patients discharge Medication needs are communicated to the pharmacist Discussion occurs on medication coverage Decision to proceed with the PA or initiate a formulary medication is determined The pharmacist fills out the plan-specific PA form The pharmacist writes a patient-specific letter of medical reasoning to accompany the PA form Approval or denial of the prescribed medication is communicated to the prescriber
Medication needs communicated to pharmacist via the treatment team
Pharmacist initiates the PA process
medications prescribed during their acute care inpatient hospitalization by identifying barriers to access (PA requirements) prior to the patient’s discharge.
Method There are 3 steps that makeup the PIPAP (Table 1). The prescription insurance coverage is identified for each admitted patient via the facilities intake process. For each patient with state-funded prescription insurance coverage (ie, Medicaid plans), the pharmacist prints a medication formulary of the preferred and nonpreferred psychiatric medications most commonly prescribed at our facility (antipsychotics, antidepressants, anxiolytics, mood stabilizers, and stimulants). This information is placed in the chart as a reference for prescribers. Upon admission to our facility, patients are assigned to a psychiatrist for the duration of their hospital stay. Each psychiatrist holds treatment team twice per week to discuss their assigned patients. Discussions may include medications (continuing, initiating, or discontinuing), therapy, patient progress, barriers to discharge, and individual patient needs. During this time, the psychiatrist communicates to the pharmacist what medications he or she would like to initiate in this patient. The pharmacist checks the medications against the prescription insurance formulary and identifies all medications that will need a PA. The pharmacist then starts the PA process. The PA process is done by completing the PA form for each medication requiring a PA. The PA form is also accompanied by a letter (letter of medical reasoning) written
Downloaded from jpp.sagepub.com at GEORGIAN COURT UNIV on February 24, 2015
Allen and Ojong-Salako
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Table 2. Examples of Patient-Specific Reasons, Used in Our Facility, for Preference of a Nonformulary Medication Included in the Letter of Medical Reasoning. Medical comorbidities Secondary to the patients’ medical comorbidities (ie, diabetes and obesity), a preferred medication may not be ideal in this patient The patient has a history of seizures, medications that lower the seizure threshold are nonpreferred in this patient Social history The patient has a history of substance abuse a formulary preferred medication with a higher risk of abuse is nonpreferred in this patient Patient history of The patient has a history of nonadherence to nonadherence oral medications. A nonpreferred formulation is preferred in this patient to increase medication adherence
Table 3. Impact of PIPAP (May 2013-April 2014). Total number of prior authorizations initiated by the pharmacist: 290 Approved 263 Denied 27 Medications requiring a prior authorization Antipsychotics 248 Antidepressants 17 Anticonvulsants/mood stabilizers 3 Stimulants 8 Other 14 Prescription insurance plans Medicaid 244 Medicare 18 Commercial 26 Other 2 Abbreviation: PIPAP, pharmacist-initiated prior authorization process.
by the pharmacist that covers patient-specific reasons why the nonformulary medication is preferred over formulary options (Table 2). The PA and pharmacist-derived letter of medical reasoning is then faxed to the prescription insurance company for consideration. If it is determined that a medication will not be approved (the PA was denied), this information is communicated by the pharmacist to the prescriber. The prescriber then determines whether he or she will change the patient’s medication regimen or write a letter of appeal. Each of these steps is done prior to the patient’s discharge from our facility. Coverage determination is normally received within 24 hours of the PA request. The pharmacist also helps to identify vouchers and coupons that patients may use in the incidence that the medications are covered but the co-pay is high. The PIPAP was implemented in May 2013. Since its start date the pharmacist has initiated 290 PAs (Table 3). The PIPAP is seen as a valued service to the facility secondary to meeting a previously unmet need for patient care.
Expansion of the PIPAP The PIPAP has been functioning for 1 year. Plans to expand the PIPAP and ideally increase its value at the facility include
collecting data on readmission rates and patient adherence to the prescribed medications. The intent is to determine whether there is a correlation between the PIPAP and the number of readmissions, reasons for readmission, and time between the last discharge and the readmission date. This information will then be compared to patients who did not require a PA for their prescribed medications and therefore did not utilize the PIPAP. Another method of planned expansion is to apply for a grant in order to fund the development of an automated PA process for the facility. At the present time, the pharmacist is the primary health care professional within this facility developing a letter of medical reasoning to accompany the standard PA form. An automated PA process will allow these letters to be selfgenerated after the identification of patient-specific key words input by the user of the automated PA process.
Conclusion Prescribers, pharmacists, pharmaceutical companies, and consumers for various reasons may view PA programs negatively. A standardized process may help to decrease some of the barriers associated with PA programs, increase patient access to the prescribed medication, and aid in medication adherence after discharge. Pharmacist and other health care professionals are ideal candidates to implement a PA program in their facility. Their medical and pharmacologic knowledge can aid in rationalizing the use of a medication as opposed to another as well as determining alternative treatment options in the event that an intended medication is not covered by the MCO. Acknowledgment The authors acknowledge Norma Exalien, PharmD.
Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
References 1. Phillips C, Larson L. Evaluating the operational performance and financial effects of a drug prior authorization program. J Managed Care Pharm. 1997;3(6):699-706. 2. Hamel M, Epstein A. Prior-authorization programs for controlling drug spending. N Engl J Med. 2004;351(21):2156-2158. 3. MacKinnon N, Kumar R. Prior authorization programs: a critical review of the literature. J Managed Care Pharm. 2001;7(4): 297-302. 4. LaPensee K. Analysis of a prescription drug prior authorization program in a Medicaid health maintenance organization. J Managed Care Pharm. 2003;9(1):36-44. 5. Academy of Managed Care Pharmacy. Concepts in Managed Care Pharmacy Series—Prior Authorization; April 2012. http://www. amcp.org/prior_authorization/. Accessed November 30, 2014.
Downloaded from jpp.sagepub.com at GEORGIAN COURT UNIV on February 24, 2015
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Journal of Pharmacy Practice 28(1)
6. Academy of Managed Care Pharmacy. Concepts in Managed Care Pharmacy Series—Formulary Management; November, 2009. http://www.amcp.org/WorkArea/DownloadAsset.aspx?id¼9298. Accessed November 30, 2014. 7. Gonzalez J, Williams J, Noel P, et al. Adherence to mental health treatment in a primary care clinic. J Am Board Fam Med. 2005; 18(2):87-96.
8. Ascher-Svanum H, Faries DE, Zhu B, et al. Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care. J Clin Psychiatry. 2006;67(3): 453-460. 9. Ho PM, Rumsfeild JS, Masoudi FA, et al. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med. 2006;166(17):1836-1841.
Downloaded from jpp.sagepub.com at GEORGIAN COURT UNIV on February 24, 2015
Pharmacist-Initiated Prior Authorization Process to Improve Patient Care in a Psychiatric Acute Care Hospital
Journal of Pharmacy Practice 2015, Vol. 28(1) 31-34 ª The Author(s) 2014 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0897190014562383 jpp.sagepub.com
Shari N. Allen, PharmD, BCPP1, and Mebanga Ojong-Salako, PharmD2
Abstract A prior authorization (PA) is a requirement implemented by managed care organizations to help provide medications to consumers in a cost-effective manner. The PA process may be seen as a barrier by prescribers, pharmacists, pharmaceutical companies, and consumers. The lack of a standardized PA process, implemented prior to a patient’s discharge from a health care facility, may increase nonadherence to inpatient prescribed medications. Pharmacists and other health care professionals can implement a PA process specific to their institution. This article describes a pharmacist-initiated PA process implemented at an acute care psychiatric hospital. This process was initiated secondary to a need for a standardized process at the facility. To date, the process has been seen as a valuable aspect to patient care. Plans to expand this process include collecting data with regards to adherence and readmissions as well as applying for a grant to help develop a program to automate the PA program at this facility. Keywords prior authorization, pharmacist, managed care organization, adherence
Prior Authorization Programs A prior authorization (PA) program is a tool implemented by managed care organizations (MCOs) designed to permit plan members to receive medications that are safe and effective for their condition in a cost-effective manner. PA requirements for MCOs may differ from plan to plan and state to state and may be based on therapeutic rationale, clinical needs, and cost. PA guidelines often encourage the use of generically available medications, the use of alternative less costly drugs used for the same indication, the use of a step therapy approach to care, restrictions on clinical situations in which expensive medications may be used, or restriction of the dose or quantity (ie, quantity limits) of a medication while still maintaining a therapeutic dosage range.1,2 In order to qualify for reimbursement from a drug requiring a PA, prescribers must obtain preapproval prior to prescribing the medication.3 The PA process can be used by prescribers and patients to request coverage for the more costly medication that is not included on the formulary. The prescriber will provide more information as to why he or she prefers a particular medication. The MCO will review patient characteristics, diagnosis, and prescription history. This information is then utilized by the MCO to determine coverage on a case-by-case basis.4-6 Drugs that require a PA will not be approved for payment until conditions for approval of the drug are met. The PA process can be used to enforce a step therapy approach to care.1 A step therapy approach to care ensures
that an established cost-effective drug therapy is used prior to progressing to other therapies.5 A step therapy approach to care requires the use of a clinically recognized first-line drug before approval of another more expensive agent.5 Step therapy approach to care consists of reviewing a patient’s past prescription claims history to qualify a patient for coverage at the point of sale. If the patient has a claim history of utilizing a first-line drug, he or she may qualify for coverage of a second-line agent without the need for the prescriber to submit a PA request.5 A PA can be used to prevent inappropriate use of medications. Some MCOs may limit coverage to Food and Drug Administration-approved conditions and requires a PA for off-label uses. A PA request for an off-label use requires documentation from the prescriber to confirm the use for which the product was prescribed. In the PA request, the prescriber may have to provide evidence supporting the unapproved use.5 In addition, MCOs may require PAs for select
1 Philadelphia College of Osteopathic Medicine School of Pharmacy, Suwanee, GA, USA 2 PGY-1 Resident VA Texas Valley Coastal Bend Health Care System, Harlingen, TX, USA
Corresponding Author: Shari N. Allen, Philadelphia College of Osteopathic Medicine School of Pharmacy, 625 Old Peachtree Road NW, Suwanee, GA 30024, USA. Email: [email protected]
Downloaded from jpp.sagepub.com at GEORGIAN COURT UNIV on February 24, 2015
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Journal of Pharmacy Practice 28(1)
medications such as chemotherapy agents. The PA is intended to ensure that the selected medication is clinically necessary and prescribed by the proper specialty expert before approving the medication.5 Prescribers, pharmacists, pharmaceutical companies, and consumers may be impacted negatively and/or have negative views of PA programs. Pharmaceutical companies view PA programs as a barrier to getting their drugs on the market.3 Likewise, consumers may view PA programs as a barrier to accessing their medications, which can lead to dissatisfaction with their health care providers, insurance companies, or pharmacy.3,4 Some prescribers view PA paperwork as too time consuming and thus can lead to not prescribing a medication that the physician feels would be most beneficial to a patient.3 Community pharmacists also view PA programs and requirements as a time-consuming burden that is impeding their patients from getting access to their medications.3 These negative views on PA programs often stem from the lack of health care settings having an established standardized PA process. A lack of a standardized PA process has caused some prescribers to view PA programs as a barrier to patients getting their medications and thus interfering with adherence. Implementing a well-designed evidence-based PA process is time effective, optimizes patient care, and reduces medication error and waste.3
Pharmacist-Initiated PA Process Rationale A pharmacist-initiated prior authorization process (PIPAP) was implemented at a 54-bed not-for-profit, acute care psychiatric hospital. The program was initiated in order to address the lack of a formal PA process in the facility. Previous to the PIPAP, PAs were being completed by therapy staff and case management. Barriers encountered prior to the PIPAP included time constraints to complete PA forms, a lack of knowledge of the PA criteria required by MCOs, and unfamiliarity with MCO’s formularies leading to a lack of identification of PA needs prior to a patient’s discharge. These barriers may result in delayed outpatient adherence of inpatient-prescribed medications. Nonadherence to mental health treatment is related to poor outcomes.7 Ascher-Svanum et al completed a multisite, 3-year, prospective, naturalistic study to determine the relationship between medication adherence and long-term functional outcomes in the treatment of schizophrenia. In this study, nonadherence to treatment with antipsychotics in patients with schizophrenia was associated with poorer functional outcomes one of which included a greater risk of psychiatric hospitalizations. Nonadherence in the first year was a predictor for poorer outcomes in the next 2 years.8 Similar results of poorer outcomes have been found in nonadherence to medications used to treat medical conditions such as diabetes.9 The objectives of the PIPAP at our facility are to establish a formal process for identifying PA needs of admitted patients and improve patient’s access to their psychiatric
Table 1. Pharmacist-Initiated Prior Authorization Process (PIPAP). Steps in the PIPAP
Explanation
Medication formulary placed in patient chart
A patient-specific medication (psychiatric medications) formulary is placed in the chart as a reference for prescribers The formulary also serves to help the pharmacist and others identify barriers to acquiring the prescribed medication prior to a patients discharge Medication needs are communicated to the pharmacist Discussion occurs on medication coverage Decision to proceed with the PA or initiate a formulary medication is determined The pharmacist fills out the plan-specific PA form The pharmacist writes a patient-specific letter of medical reasoning to accompany the PA form Approval or denial of the prescribed medication is communicated to the prescriber
Medication needs communicated to pharmacist via the treatment team
Pharmacist initiates the PA process
medications prescribed during their acute care inpatient hospitalization by identifying barriers to access (PA requirements) prior to the patient’s discharge.
Method There are 3 steps that makeup the PIPAP (Table 1). The prescription insurance coverage is identified for each admitted patient via the facilities intake process. For each patient with state-funded prescription insurance coverage (ie, Medicaid plans), the pharmacist prints a medication formulary of the preferred and nonpreferred psychiatric medications most commonly prescribed at our facility (antipsychotics, antidepressants, anxiolytics, mood stabilizers, and stimulants). This information is placed in the chart as a reference for prescribers. Upon admission to our facility, patients are assigned to a psychiatrist for the duration of their hospital stay. Each psychiatrist holds treatment team twice per week to discuss their assigned patients. Discussions may include medications (continuing, initiating, or discontinuing), therapy, patient progress, barriers to discharge, and individual patient needs. During this time, the psychiatrist communicates to the pharmacist what medications he or she would like to initiate in this patient. The pharmacist checks the medications against the prescription insurance formulary and identifies all medications that will need a PA. The pharmacist then starts the PA process. The PA process is done by completing the PA form for each medication requiring a PA. The PA form is also accompanied by a letter (letter of medical reasoning) written
Downloaded from jpp.sagepub.com at GEORGIAN COURT UNIV on February 24, 2015
Allen and Ojong-Salako
33
Table 2. Examples of Patient-Specific Reasons, Used in Our Facility, for Preference of a Nonformulary Medication Included in the Letter of Medical Reasoning. Medical comorbidities Secondary to the patients’ medical comorbidities (ie, diabetes and obesity), a preferred medication may not be ideal in this patient The patient has a history of seizures, medications that lower the seizure threshold are nonpreferred in this patient Social history The patient has a history of substance abuse a formulary preferred medication with a higher risk of abuse is nonpreferred in this patient Patient history of The patient has a history of nonadherence to nonadherence oral medications. A nonpreferred formulation is preferred in this patient to increase medication adherence
Table 3. Impact of PIPAP (May 2013-April 2014). Total number of prior authorizations initiated by the pharmacist: 290 Approved 263 Denied 27 Medications requiring a prior authorization Antipsychotics 248 Antidepressants 17 Anticonvulsants/mood stabilizers 3 Stimulants 8 Other 14 Prescription insurance plans Medicaid 244 Medicare 18 Commercial 26 Other 2 Abbreviation: PIPAP, pharmacist-initiated prior authorization process.
by the pharmacist that covers patient-specific reasons why the nonformulary medication is preferred over formulary options (Table 2). The PA and pharmacist-derived letter of medical reasoning is then faxed to the prescription insurance company for consideration. If it is determined that a medication will not be approved (the PA was denied), this information is communicated by the pharmacist to the prescriber. The prescriber then determines whether he or she will change the patient’s medication regimen or write a letter of appeal. Each of these steps is done prior to the patient’s discharge from our facility. Coverage determination is normally received within 24 hours of the PA request. The pharmacist also helps to identify vouchers and coupons that patients may use in the incidence that the medications are covered but the co-pay is high. The PIPAP was implemented in May 2013. Since its start date the pharmacist has initiated 290 PAs (Table 3). The PIPAP is seen as a valued service to the facility secondary to meeting a previously unmet need for patient care.
Expansion of the PIPAP The PIPAP has been functioning for 1 year. Plans to expand the PIPAP and ideally increase its value at the facility include
collecting data on readmission rates and patient adherence to the prescribed medications. The intent is to determine whether there is a correlation between the PIPAP and the number of readmissions, reasons for readmission, and time between the last discharge and the readmission date. This information will then be compared to patients who did not require a PA for their prescribed medications and therefore did not utilize the PIPAP. Another method of planned expansion is to apply for a grant in order to fund the development of an automated PA process for the facility. At the present time, the pharmacist is the primary health care professional within this facility developing a letter of medical reasoning to accompany the standard PA form. An automated PA process will allow these letters to be selfgenerated after the identification of patient-specific key words input by the user of the automated PA process.
Conclusion Prescribers, pharmacists, pharmaceutical companies, and consumers for various reasons may view PA programs negatively. A standardized process may help to decrease some of the barriers associated with PA programs, increase patient access to the prescribed medication, and aid in medication adherence after discharge. Pharmacist and other health care professionals are ideal candidates to implement a PA program in their facility. Their medical and pharmacologic knowledge can aid in rationalizing the use of a medication as opposed to another as well as determining alternative treatment options in the event that an intended medication is not covered by the MCO. Acknowledgment The authors acknowledge Norma Exalien, PharmD.
Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
References 1. Phillips C, Larson L. Evaluating the operational performance and financial effects of a drug prior authorization program. J Managed Care Pharm. 1997;3(6):699-706. 2. Hamel M, Epstein A. Prior-authorization programs for controlling drug spending. N Engl J Med. 2004;351(21):2156-2158. 3. MacKinnon N, Kumar R. Prior authorization programs: a critical review of the literature. J Managed Care Pharm. 2001;7(4): 297-302. 4. LaPensee K. Analysis of a prescription drug prior authorization program in a Medicaid health maintenance organization. J Managed Care Pharm. 2003;9(1):36-44. 5. Academy of Managed Care Pharmacy. Concepts in Managed Care Pharmacy Series—Prior Authorization; April 2012. http://www. amcp.org/prior_authorization/. Accessed November 30, 2014.
Downloaded from jpp.sagepub.com at GEORGIAN COURT UNIV on February 24, 2015
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Journal of Pharmacy Practice 28(1)
6. Academy of Managed Care Pharmacy. Concepts in Managed Care Pharmacy Series—Formulary Management; November, 2009. http://www.amcp.org/WorkArea/DownloadAsset.aspx?id¼9298. Accessed November 30, 2014. 7. Gonzalez J, Williams J, Noel P, et al. Adherence to mental health treatment in a primary care clinic. J Am Board Fam Med. 2005; 18(2):87-96.
8. Ascher-Svanum H, Faries DE, Zhu B, et al. Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care. J Clin Psychiatry. 2006;67(3): 453-460. 9. Ho PM, Rumsfeild JS, Masoudi FA, et al. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med. 2006;166(17):1836-1841.
Downloaded from jpp.sagepub.com at GEORGIAN COURT UNIV on February 24, 2015
