Prior authorization program

Patient criterion Patient must qualify for treatment by meeting specific criteria (usually used in conjunction with a prior authorization program)... 

An emerging trend in formulary management is the decline in the utilization of enforcement and restriction strategies such as switch and prior authorization programs (Litton et al., 2000). These programs typically have high administrative and internal resource costs, significant time... 

In general, MCOs with formulary programs use a variety of methods to enforce formulary adherence. These methods vary in their restrictions, and typically include financial incentives for both prescribers and patients. Table 43.1 lists and defines typical restriction methods, such as prior authorization and treatment limitations. Table 43.2 lists commonly used enforcement strategies and financial incentives, including switch programs, differenti-ated/tiered co-payments, and education programs. 

Change" as used here refers to a new or fundamentally different system or procedure. Replacement in kind is excluded. All true modifications must be well documented. No modifications should be permitted without prior authorization and follow-up documentation. Extensive or higher levels of change should require higher levels of authorization. A carefully planned and executed Change Control Program must be instituted to prevent the hazards that often arise from quick responses. 

Effective October 22, 2001, PEG-Intron only will be made available through the PEG-1 ntron Access Assurance program. Pharmacists must obtain an order authorization number prior to placing an order with their wholesaler. To obtain this number, call (888) 437-2608 to provide the patient s Access Assurance ID and the quantity to be dispensed (maximum 4 units). Patients without an Access Assurance ID also may call this number to enroll. Next, contact the wholesaler and provide the authorization number and order information. 

In December 1997, Secretary of Defense William Cohen announced a departmentwide anthrax immunization program for high-risk military personnel. Implementation began in March 1998. On May 18, 1998, the Secretary authorized the vaccination of all military forces (Cohen, 1998). Almost 2.5 million troop-equivalent doses of vaccine were required to implement the Secretary s decision, much more than had ever been produced by the licensed manufacturer in its entire history. Prior to Desert Storm, the primary vaccine users had been veterinary, laboratory, and industrial workers at risk of infection, for whom an estimated 60,000 doses of Anthrax Vaccine Absorbed (AVA) were distributed between 1974 and 1989, an average of 4,533 doses per year (foellenbeck et al., 2002). During Desert Storm, approximately 150,000 troops received 300,000 doses of AVA, without accurate recording of recipients or adverse reactions. 

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