Prescription drug prior authorization: costs to pharmacies and physicians

To determine the costs of prior authorization (PA) for prescription drugs in outpatient settings in the US and Canada.

Systematic literature review.

We systematically searched PubMed, CINAHL, and Embase using keywords and controlled vocabulary to obtain English-language articles addressing PA and costs. Two authors reviewed each article to determine eligibility for the study.

The search identified 14 articles that met inclusion criteria. Four examined the time and costs of PA to pharmacies. All were conducted at hospital clinics. Mean times to complete PA varied from 15 minutes to 24 minutes. Labor costs varied from $15 to $63. One study estimated the mean time to complete a PA appeal to be 74 minutes. Eleven studies measured the time and/or costs of PA in physician practices. Four understated and 1 may have overstated time spent on PA. Mean estimates from the remaining studies varied from 25 to 64 minutes. Six studies also measured labor-related costs. The studies that misstated time also misstated labor costs. The 3 remaining mean estimates varied from $21 to $49.

Providers incur substantial costs when completing PAs. However, not enough studies have been done to accurately estimate the magnitude of these costs or identify key sources of cost variation. Further, there is no research on the costs of PA to community, mail-order, or specialty pharmacies.