College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA.
Pharmacy Ambulatory Clinical Care Center, University of Utah Health, Murray, UT, USA.
Am J Health Syst Pharm. 2021 May 24;78(11):982-988. doi: 10.1093/ajhp/zxab083.
Direct and indirect costs related to the growth of specialty pharmacy services and the insurance navigation process for specialty clinic patients are discussed, and development and implementation of a pharmacy-driven and system-wide prior authorization (PA) processing center within a health system are described.
Expensive specialty drugs require PA. Due to the concentration of specialists, health systems with multiple specialties experience higher PA burden and resulting care delays. Although clinic staff typically handle PA requests, health-system specialty pharmacies are well positioned to support patients, clinic staff, and physicians by assuming responsibility for the PA process entirely. University of Utah Health established its Pharmacy Ambulatory Clinical Care Center (PAC3) to centralize PA processing for selected specialty and primary care clinics within the health system. In fiscal year 2019, the PAC3 team (10 pharmacy technician and 1.5 pharmacist full-time equivalents) completed over 13,000 PAs. The pharmacy labor cost increase was significant; however, the benefits gained from increased services, quality, and financial strength surpassed all costs associated with the implementation and maintenance of the pharmacy operation. Other tangible benefits included decreased delays in therapy initiation, increased patient satisfaction, increased clinic visits, and increased staff and provider satisfaction and engagement.
Increased PA requests associated with specialty drugs have placed considerable stress and staff burden on specialty clinics within health systems. However, development and implementation of an efficient PA processing infrastructure within a health-system specialty pharmacy may reduce the burden, increase financial strength, and improve the patient experience.
讨论与专科药房服务增长以及专科诊所患者保险导航流程相关的直接和间接成本，并描述在医疗系统内开发和实施药房主导且系统范围的预先授权（PA）处理中心的情况。
昂贵的专科药物需要 PA。由于专科医生的集中，拥有多种专科的医疗系统会面临更高的 PA 负担和由此导致的护理延迟。尽管诊所工作人员通常负责处理 PA 请求，但医疗系统的专科药房通过完全承担 PA 流程的责任，能够为患者、诊所工作人员和医生提供更好的支持。犹他大学健康中心（University of Utah Health）成立了药房门诊临床护理中心（Pharmacy Ambulatory Clinical Care Center，PAC3），以集中处理医疗系统内选定的专科和初级保健诊所的 PA 流程。在 2019 财年，PAC3 团队（10 名药剂师和 1.5 名全职药剂师）完成了超过 13000 次 PA。药房劳动力成本的增加是显著的；然而，从增加的服务、质量和财务实力中获得的收益超过了实施和维护药房运营所带来的所有成本。其他有形收益包括减少治疗启动延迟、提高患者满意度、增加诊所就诊次数以及提高员工和提供者的满意度和参与度。
与专科药物相关的 PA 请求增加给医疗系统内的专科诊所带来了相当大的压力和员工负担。然而，在医疗系统的专科药房内开发和实施高效的 PA 处理基础设施可以减轻负担、增强财务实力并改善患者体验。
