Pharmacy resident involvement in prior-authorization drug request adjudication
Sara R Britnell1, Jamie N Brown2, Mohamed G Hashem2
1Pharmacy Department, Durham Veterans Affairs Health Care System, Durham, NC sara.britnell@va.gov.
Summary
Pharmacy residents achieved significant cost savings by adjudicating prior-authorization drug requests (PADRs) in a VA system. Their interventions, primarily due to formulary alternatives, saved over $169,000 annually.
Area of Science:
- Health economics
- Pharmacy practice
- Healthcare management
Background:
- Prior-authorization drug requests (PADRs) are a critical component of medication management in healthcare systems.
- Pharmacy resident involvement in clinical and administrative tasks is increasingly recognized for its value.
- The Veterans Affairs (VA) healthcare system utilizes PADRs to manage medication costs and ensure appropriate therapy.
Purpose of the Study:
- To evaluate the economic impact of pharmacy residents adjudicating prior-authorization drug requests (PADRs) within a VA healthcare system.
- To quantify the cost savings generated by pharmacy residents' formulary interventions during PADR reviews.
Main Methods:
- A retrospective review of PADRs adjudicated by pharmacy residents from 2015-16 was conducted.
- Included PADRs required formulary intervention and met specific inclusion criteria.
- Cost savings were calculated based on adjudication decisions made by residents under preceptor supervision.
Main Results:
- Of 752 total PADRs, 42 met inclusion criteria for analysis.
- Most requests (90%) were for general medicine, with 9.5% for oncology medications.
- Resident adjudication resulted in $169,877.53 in direct cost savings over 12 months, averaging $4,044.70 per request.
Conclusions:
- Pharmacy residents' adjudication of PADRs in a VA setting leads to substantial cost savings.
- The involvement of residents in PADR reviews offers a valuable opportunity for economic benefit within the healthcare system.
- This study highlights the financial advantages of integrating pharmacy residents into prior-authorization processes.
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