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The economic burden associated with prior authorizations in an allergist office

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Costs for managed care organizations to process prior authorizations (PAs) for nonformulary medications have been estimated to be $20–25 per request. Costs for physicians to process these requests have not been studied extensively. A data collection tool was developed and used by physicians and nurses to document time spent on processing PAs. Data were collected over 8 weeks and 117 requests were processed. Nurses averaged 5.6 ± 6.5 calls per day per nurse and spent an average of 17 minutes per call. Physicians averaged 1.9 ± 1.2 calls per day averaging 5.8 ± 5.0 minutes per call. During the study period nurses spent >40 hours on 231 calls and physicians spent >8 hours on 154 calls. Based on the hourly rate of the nurses and physicians, the total cost in this specialty practice was $17.77 per PA. Of the 117 PA requests, 98.7% were approved the first time they were processed. There are substantial costs with processing PAs for nonformulary drugs on the physician office side of managed care as well as on the insurance side of the process. Specialty physicians should have a different process for obtaining nonformulary medications because almost 100% of their requests are granted.
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Document Type: Research Article

Publication date: 2006-03-01

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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