Development of the Burden of Prior Authorization of Psychotherapeutics (BoPAP) Scale to Assess the Effects of Prior Authorization Among Texas Medicaid Providers

Brown, Carolyn M.; Nwokeji, Esmond; Rascati, Karen L.; Zachry, Woodie M.; Phillips, Glenn

doi:10.1007/s10488-009-0220-4

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…Orthopaedic procedures are only a small fraction of the medical therapies impacted by prior authorization. In fact, prior authorization has created a barrier to patient care for a spectrum of treatments ranging from oncology to pain management [33][34][35] . A recent article by Yu et al describes the burden of prior authorization for proton beam therapy, which led to >60% of cancer patients initially being denied authorization and treatment delays of up to 4 months 35 .…”

Section: Discussionmentioning

confidence: 99%

Inconsistent Reporting of Preauthorization Medical Criteria for Osteochondral Allograft Transplantation Surgery

Tabbaa¹,

Bugbee²,

Provencher³

et al. 2022

Journal of Bone and Joint Surgery

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Background:Although osteochondral allograft (OCA) transplantation has been a standard treatment for patients with osteochondral lesions, there is a disagreement in commercial payers’ medical criteria regarding the definition of medical suitability and thus authorization for OCA transplantation. The primary goal of this study was to understand where consensus between a committee of experienced cartilage restoration surgeon scientists and payer policies existed and where there was significant disagreement.Methods:U.S. private payers were identified by reviewing health insurance market research literature. Medical criteria were then obtained from publicly available payer medical polices. A literature review was conducted to identify supporting evidence for consensus statements based on private payer medical criteria. The MOCA (Metrics of Osteochondral Allograft) Committee, 30 experienced surgeons and subject-matter experts in OCA transplantation, used a Likert scale of 1 (strongly disagree) to 5 (strongly agree) to rank each statement. The extent of agreement and disagreement among participants was measured for each statement. Consensus was defined as agreement or disagreement of >75%.Results:Fifty-seven statements regarding relevant medical criteria for OCA transplantation were included in the survey. All 30 MOCA Committee members completed the survey (100% response rate). Over half of the statements (52.6%) did not reach consensus. Of the remaining 27 statements that reached consensus, respondents agreed or strongly agreed with 16 statements, and disagreed or strongly disagreed with 11 statements. Inconsistent voting was observed for statements related to osteoarthritis, inflammation, and degenerative changes.Conclusions:Commercial payers are not consistent in the medical criteria used to define patient eligibility for authorization of OCA transplantation. In contrast, an expert panel of cartilage surgeons reached a consensus that OCA transplantation was clearly suitable for a variety of specific indications. This study demonstrates the need to standardize medical criteria for cartilage restoration based on the most current literature, as well as in conjunction with experienced cartilage restoration experts.Level of Evidence:Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Inconsistent Reporting of Preauthorization Medical Criteria for Osteochondral Allograft Transplantation Surgery

Tabbaa¹,

Bugbee²,

Provencher³

et al. 2022

Journal of Bone and Joint Surgery

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“…Acidic solutions are commonly used in the pharmaceutical industry to inactivate viruses in the isolation of viral proteins and for cleaning and prevention of infection. 34,35 Acid-buffered saline has been investigated as a topical therapy for various upper respiratory viruses, showing inactivation of influenza A, decreased symptoms and viral shedding of influenza A, reduced viral shedding of human rhinovirus with the use of solutions and nasal gels, and reduced symptom severity and duration of illness in the common cold. 34,36 Unfortunately, SARS-CoV-2 has been shown to be highly stable in a range of pH environments, limiting the viability of acidic therapies as options against this virus.…”

Section: Agents With Antiviral Capabilitymentioning

confidence: 99%

Intranasal Antiviral Drug Delivery and Coronavirus Disease 2019 (COVID‐19): A State of the Art Review

Higgins

Wu²,

Illing³

et al. 2020

Otolaryngol.--head neck surg.

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Objective To provide a state of the art review of intranasal antiviral drug delivery and to discuss current applications, adverse reactions, and future considerations in the management of coronavirus disease 2019 (COVID-19). Data Sources PubMed, Embase, and Clinicaltrials.gov search engines. Review Methods A structured search of the current literature was performed of dates up to and including April 2020. Search terms were queried as related to topics of antiviral agents and intranasal applications. A series of video conferences was convened among experts in otolaryngology, infectious diseases, public health, pharmacology, and virology to review the literature and discuss relevant findings. Conclusions Intranasal drug delivery for antiviral agents has been studied for many years. Several agents have broad-spectrum antiviral activity, but they still require human safety and efficacy trials prior to implementation. Intranasal drug delivery has potential relevance for future clinical trials in the settings of disease spread prevention and treatment of SARS-CoV-2 and other viral diseases. Implications for Practice Intranasal drug delivery represents an important area of research for COVID-19 and other viral diseases. The consideration of any potential adverse reactions is paramount.

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Containing Cost Despite the Cost

Farley¹

2010

Medical Care

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Development of the Burden of Prior Authorization of Psychotherapeutics (BoPAP) Scale to Assess the Effects of Prior Authorization Among Texas Medicaid Providers

Cited by 3 publications

References 19 publications

Inconsistent Reporting of Preauthorization Medical Criteria for Osteochondral Allograft Transplantation Surgery

Inconsistent Reporting of Preauthorization Medical Criteria for Osteochondral Allograft Transplantation Surgery

Intranasal Antiviral Drug Delivery and Coronavirus Disease 2019 (COVID‐19): A State of the Art Review

Containing Cost Despite the Cost

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