Prior authorization in gynecologic oncology: An analysis of clinical impact

Smith, Anna Jo Bodurtha; Mulugeta-Gordon, Lakeisha; Pena, Daniella; Kanter, Genevieve P.; Bekelman, Justin E.; Haggerty, Ashley; Ko, Emily

doi:10.1016/j.ygyno.2022.10.002

Cited by 9 publications

(4 citation statements)

References 7 publications

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“…Our previous work found that 25 % of patients experience prior authorization for other components of gynecologic oncology care ( Smith et al, 2022 ). Patients prescribed PARP inhibitors experienced more than double this rate of prior authorization in our study.…”

Section: Discussionmentioning

confidence: 99%

“…We developed our search terms from a registry of patients experiencing prior authorization that had been developed for quality improvement and maintained in one clinic (Supplemental Table 2 ). Using previously published methodology, we validated the search terms through chart reviews using examples of these identified patients who experienced prior authorization ( Smith et al, 2022 , Smith et al, 2023 ).…”

Section: Methodsmentioning

confidence: 99%

“…The prior authorization process is typically completed by prescribing clinicians and/or supporting staff electronically or over the phone, and the insurance company then approves or denies coverage. While prior authorizations are designed to reduce medically unnecessary tests and promote high value care, our prior work has shown that prior authorization is not consistently evidence-based, and its occurrence is associated with cancer treatment delays of 2 or more weeks ( Smith et al, 2022 , Smith et al, 2023 ). Ultimately, these delays may impact survival and contribute to worse morbidity and mortality for patients with ovarian cancer.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prior authorization for FDA-approved PARP inhibitors in ovarian cancer

Smith,

Apple,

Hugo

et al. 2024

Gynecologic Oncology Reports

Self Cite

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prior authorization for FDA-approved PARP inhibitors in ovarian cancer

Smith,

Apple,

Hugo

et al. 2024

Gynecologic Oncology Reports

Self Cite

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“…There has been an abundance of interventions and research addressing the clinical impact of PA requirements, as well as the regular use of medical assistants, nurses, and pharmacists to address PAs. x,xi,xii,xiii,xiv,xv,xvi However, these interventions rarely invest resources upstream of the prescription being written for a medication likely to require PA. In this paper, we describe a quality improvement intervention at our institution that invested resources prior to a prescription for a specialty pharmacy medication being sent to the pharmacy.…”

Section: Introductionmentioning

confidence: 99%

Implementation of an Enhanced Medication Access Workflow within a Health System Specialty Pharmacy: Impact on Patient & Clinician Experience

Harkonen,

Cuttitta,

Henderson

et al. 2024

Preprint

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Purpose: The initiation of specialty medications is associated with patient access challenges and clinician burden. This intervention invested resources upstream of the prescription being written. The evaluation assessed the impact on patient and clinician experience. Methods: The specialty pharmacy intervention was designed to improve medication access within five medical specialty clinics by utilizing an embedded medication access team assigned to patients and prescribers of targeted medications. We used a multi-methods evaluative approach. Semi-structured qualitative interviews provided an understanding of clinician experience. To quantitatively assess associations between the referral process and patient experience, we analyzed the emotional valence of patient portal messages using a retrospective cohort study and an event study framework of a non-randomized, stepped wedge implementation design. Results: The intervention was associated with an increase in the net positive emotional valence of patient portal messages (AME, 5.3; 95% CI, 3.8-6.8). Except for gastroenterologists seeing patients for irritable bowel disease, patients cared for in all other specialties experienced statistically significant increases in net positive valence in the primary analysis. Regarding clinician experience, four major interrelated themes emerged from 17 qualitative interviews with prescribers and pharmacists: (1) decreased clinician burden, general praise, (2) improved experience & satisfaction, reduced anxiety & concerns, (3) rewarding praise for other prescribers/colleagues, and (4) excellent coordination, efficiency, and speed. Conclusion: Investing staff resources before, during, and after the prior authorization process greatly improves clinician experience. The positive valence of patient portal messages also increased suggesting patient experience improvements.

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