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Trends that Matter for Prior Authorizations

Posted by Matt Breese on Feb 24, 2016

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The following infographics highlight how health plans leverage PAs in trending therapeutic areas. Payers implement prior authorizations to control costs and restrict reimbursement for specific drugs. A clinical review of these utilization management strategies reveals that some plans often require PAs that are restrictive to the drug's FDA approved label.

Multiple Sclerosis: Over half of the largest payers that cover MS treatments implement PA policies. Click on the image to view more.



Cystic Fibrosis: A review of pharmacy benefit structures for CF treatments reveals that roughly 20% of lives require a prior authorization that is restrictive to the FDA approved label. Click on the image to view more.



Detoxification Agents: For alcohol deterrence products, roughly 1/3 of PAs are restrictive-to-label when present. Click on the image to view more.



Antidepressants: Utilization management from top payers shows that PAs for roughly 44% of lives are restrictive to their label. Click on the image to view more.


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Topics: Specialty, Industry Trends, Payer