Prior authorisation: difference between revisions
Diff·revision 4 → 5·02:03, 15 Jan 2025
Difference between revision 4 and revision 5 of Prior authorisation. 2 lines changed; the page grew by 212 bytes.
| Revision 4 — 06:16, 6 Jan 2025 DisparityDagny (talk) fix a dangling clause 1,792 bytes ±0 | Revision 5 — 02:03, 15 Jan 2025 OffLabelOdile (talk) expand §Variation 2,004 bytes +212 | ||
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| 10 | For incretin therapies it is close to universal where these drugs are covered at all, and the criteria commonly include a body-mass index threshold, a comorbidity, documented prior attempts at other management, and sometimes a requirement to try a specified alternative first.{{r|ada2024}} | 10 | For incretin therapies it is close to universal where these drugs are covered at all, and the criteria commonly include a body-mass index threshold, a comorbidity, documented prior attempts at other management, and sometimes a requirement to try a specified alternative first.{{r|ada2024}} |
| 11 | 11 | ||
| + | 12 | Its effect on access is substantial. Requirements add delay, administrative burden on prescribers, and a failure mode in which coverage is denied for a prescription a clinician judged appropriate.{{r|kyle2021}} | |
| + | 13 | ||
| 12 | == How it operates == | 14 | == How it operates == |
| 13 | A prescriber submits a request with supporting documentation; the payer assesses it against published or unpublished criteria; approval, denial, or a request for further information follows. Denials may be appealed, in a process with its own timelines.{{r|kyle2021}} | 15 | A prescriber submits a request with supporting documentation; the payer assesses it against published or unpublished criteria; approval, denial, or a request for further information follows. Denials may be appealed, in a process with its own timelines.{{r|kyle2021}} |