Prior Authorization in Healthcare - How Big Is It?
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3 سال پیش
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A 2021 Article in the
A 2021 Article in the Journal of the American Medical Association by Dr. Aaron Schwartz from the University of Pennsylvania Studies the Scope of Prior Authorization in American Healthcare.
The Study Took the 1,151 Outpatient Medications, Tests and Procedures for Which CVS Aetna Requires Prior Authorization and Applied them to a Sample of Traditional Medicare Part B Claims from 2017 and Asked the Question, "Since Traditional Medicare DOES NOT Have Prior Authorization Requirements, WHAT IF the CVS Aetna Prior Authorization Requirements Were Hypothetically Applied?"
What Would Be the Implications?
The Results:
--41% of Medicare Part B Patients Would Be Affected
--Those Patients Would Have a Median of 5 Prior Authorizations Per Year
--25% of All Medicare Part B Costs Would be Subject to Prior Authorization (Approx. 14 Million Services Per Year)
--Outpatient Medication Infusions and Injections Were the Largest Category Requiring Prior Authorization... 35% of Total Prior Authorizations and 57% of Spending
--The Top Drugs Requiring Prior Authorization Were EPO, Eylea and Rituxan
--56% of Doctors Encountered a Prior Authorization.
--The Doctor Specialties Impacted the Most by Prior Authorization Were Radiation Oncology (97% of Doctors) and Cardiology (93%) and the Least Impacted Were Pathology and Psychiatry.
Interestingly, the Study Was Funded in Part by CVS/Aetna Perhaps as a Way to Highlight their 'Cost Containment' Efforts at a Time When Their PBM is Under Scrutiny for RAISING Healthcare Costs.
Sources: https://jamanetwork.com/journals/jama...
https://www.kff.org/medicare/issue-br...
https://rappaportfoundation.org/board/
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The Study Took the 1,151 Outpatient Medications, Tests and Procedures for Which CVS Aetna Requires Prior Authorization and Applied them to a Sample of Traditional Medicare Part B Claims from 2017 and Asked the Question, "Since Traditional Medicare DOES NOT Have Prior Authorization Requirements, WHAT IF the CVS Aetna Prior Authorization Requirements Were Hypothetically Applied?"
What Would Be the Implications?
The Results:
--41% of Medicare Part B Patients Would Be Affected
--Those Patients Would Have a Median of 5 Prior Authorizations Per Year
--25% of All Medicare Part B Costs Would be Subject to Prior Authorization (Approx. 14 Million Services Per Year)
--Outpatient Medication Infusions and Injections Were the Largest Category Requiring Prior Authorization... 35% of Total Prior Authorizations and 57% of Spending
--The Top Drugs Requiring Prior Authorization Were EPO, Eylea and Rituxan
--56% of Doctors Encountered a Prior Authorization.
--The Doctor Specialties Impacted the Most by Prior Authorization Were Radiation Oncology (97% of Doctors) and Cardiology (93%) and the Least Impacted Were Pathology and Psychiatry.
Interestingly, the Study Was Funded in Part by CVS/Aetna Perhaps as a Way to Highlight their 'Cost Containment' Efforts at a Time When Their PBM is Under Scrutiny for RAISING Healthcare Costs.
Sources: https://jamanetwork.com/journals/jama...
https://www.kff.org/medicare/issue-br...
https://rappaportfoundation.org/board/
AHealthcareZ is 200+ Healthcare Finance Educational Videos.
💥 BOOK: Check out Dr. Bricker’s Book 16 Lessons in the Business of Healing here: https://www.ahealthcarez.com/healthca...
AHealthcareZ Viewers Include: Employee Benefits Professionals, HR, CFOs, Insurance Brokers, Benefits Consultants, Doctors and Nurses in Leadership Roles, Hospital and Health System Administrators, Health Insurance Carrier and PBM Professionals, Pharma and Med Device Professionals, Academic Professors and Students in Healthcare Administration and Public Health.
90,000+ Views Per Month Across All Platforms.
Visit AHealthcareZ.com to Subscribe to the Healthcare Finance Video Newsletter.
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