Prior authorisation (revision 1)
Old revision·09:00, 19 Dec 2024·PBM_Perrin
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| Prior authorisation | |
|---|---|
| Also called | Pre-authorisation, pre-approval |
| Decided by | The payer, not the prescriber |
| Common criteria | Body-mass index, comorbidity, prior therapy |
| Topic infobox · conventions | |
Prior authorisation is a requirement imposed by a payer that a prescription be approved before it will be covered. It is a coverage mechanism rather than a clinical one, and the decision is made by the payer against its own criteria.[1]
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.[1]
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