Prior authorization (PA) and step therapy are utilization management tools that have been used for decades and have demonstrated their value time and again. With innovation, they also have potential to offer decision-support and facilitate optimization of therapy while using resources wisely. However, inefficient use of these tools may create administrative burdens and potential access barriers to patient care. To examine how to improve PA and step therapy processes, AMCP convened a multidisciplinary stakeholder forum from June 25-26, 2019.
The goals of the forum were to develop recommendations to:
- Improve efficiencies around PA and step therapy processes;
- Address administrative burdens, including by recommending technology solutions;
- Increase visibility of the clinical and economic value of PA and step therapy utilization management programs;
- Collect, review, and disseminate data-driven, real-world experiences of where PA programs support clinical and economic value;
- Collect and disseminate best practices around PA appeals and denial processes.