31963 A Medicaid pharmacy concierge program: A model for reducing the burden of prior authorizations in dermatology

Abstract

Background: Studies have demonstrated that prior authorizations (PAs) are a burden for providers and reduce access to dermatology medications (DMs) for patients. Medicaid patients may experience significant delays or never receive prescribed DMs due to delays in the PA process and frequent changes in Medicaid formularies. Patients with complex medical conditions are particularly at risk as specialty medications such as biologics often require a PA. Objectives: The University of Pennsylvania Department of Dermatology in collaboration with the Penn Pharmacy outlined a Medicaid Pharmacy Concierge Program to address gaps in care due to the PA process. The goal of the program is to ensure the timely receipt of prescribed DMs for Medicaid patients. To alleviate the PA process, dermatologists will identify the appropriate medication substitutions for which the pharmacist can implement without the delay of contacting the prescribing dermatologist when medications are not covered or denied; thus minimizing the PA burden. Additionally, pharmacists will contact the patient for direct mailing instructions after approval. Furthermore, we have developed algorithms for common topical medication classes that pharmacists can reference when the prescribed medication is not covered by Medicaid or denied. For example, pharmacists can look at an algorithm for low-potency topical steroids and switch to another medication that is covered without contacting the doctor or going through the PA process. Conclusion: Streamlining the PA process through specialty pharmacies and the use of standardized substitution algorithms can reduce delays in receiving medications for Medicaid patients and the administrative burden of the PA process.