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Prior authorization to improve testing of glycosylated hemoglobin in a managed care setting

Natan R Kahan1, Dan-Andrei Waitman, Shimon Blackman

  • 1Medical Division, Leumit Health Fund, PO Box 20083, Tel Aviv 64738, Israel. nkahan@leumit.co.il

The American Journal of Managed Care
|September 15, 2009
PubMed

Insights

Revoking prior authorization for diabetes medications led to a significant drop in essential A1C testing rates. Continued education is crucial to maintain quality care standards after policy changes.

Area of Science:

  • Health Services Research
  • Clinical Pharmacy
  • Diabetes Management

Background:

  • Prior authorization (PA) is a managed care tool to ensure appropriate medication use.
  • The impact of PA revocation on adherence to essential monitoring tests is not well-documented.

Purpose of the Study:

  • To evaluate the effect of rescinding a PA requirement on glycosylated hemoglobin (A1C) testing rates.
  • To assess A1C testing adherence among new users of expensive diabetes medications after PA removal.

Main Methods:

  • Retrospective electronic patient record (EPR) database study.
  • Analysis of A1C testing rates in new diabetes medication users before and after PA revocation.
  • Calculation of testing proportions and 95% confidence intervals (CI).

Main Results:

  • A1C testing rates decreased from 100% during the PA period to a range of 85.6%-94.4% after revocation.
  • No statistically significant monthly variance in testing rates was observed post-revocation.
  • The study identified a notable decline in essential diabetes monitoring.

Conclusions:

  • Prior authorization effectively ensured 100% A1C testing for diabetes medication monitoring in the studied setting.
  • Revocation of PA necessitates ongoing educational initiatives to sustain optimal patient care and adherence to guidelines.
  • Managed care organizations should consider continuous quality improvement strategies beyond initial policy implementation.
Abstract

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