Examining the Impact of a Prior Authorization Program on Rural Child and Adolescent Psychiatry Patients and Families

Abstract

Introduction The objective of this study was to examine the impact of the prior authorization (PA) process from the perspective of rural child and adolescent psychiatry patients' families. Methods All patient families who visited an outpatient behavioral health clinic in rural Appalachia for psychiatry services between July and October 2018 were eligible for the study. Caregivers of children who were prescribed medications eligible for PA or who reported problems with PA were offered a paper survey to complete anonymously and return to a drop box after the visit. Results In total, 37 respondents reported 55 different psychiatric medications affected, primarily stimulants (n=22). Just over 75% (n=28) of respondents reported delays in receiving their medication. Delays ranged anywhere from less than a day to more than a month. During those delays, respondents reported their children experienced many different adverse events when they were not receiving their medication. Commonly reported consequences of the delays included behavioral and emotional issues at home and at school, physical side effects from drug withdrawal, and increased aggression. Respondents also reported an increase in financial burden. In some cases, the educational opportunities available to the children were also restricted. Conclusion Rural families face limited access to psychiatric care and significant unmet needs. The study documents additional burden for rural families related to the PA process, including financial, behavioral, emotional, and educational consequences. This preliminary data indicates a need for further study and highlights the necessity of considering potential burdens for families when creating PA policies.