In an effort to address barriers that patients and health care providers often face when putting patient-centered care models into practice, a coalition that includes the American Pharmacists Association (APhA) is urging health plans, benefit managers and others to reform prior authorization requirements imposed on medical tests, procedures, devices and drugs.

As the pharmacist-based organization in the coalition, APhA joins 16 other health care organizations, led by the American Medical Association (AMA). In addition to pharmacists and physicians, the coalition had representation from hospitals, medical groups, and patients.

Prior authorization is a health plan cost-control process requiring providers to obtain approval before performing a service to qualify for payment. Health insurers frequently require prior authorization before patients can get certain drugs or treatments. It can also delay or interrupt medical services and divert significant resources from patient care and complicate medical decisions.

To address obstacles that prior authorization can pose to patient-centered care, the coalition is advocating for an industry-wide reassessment of these programs that would align with 21 newly developed principles. These principles address the following broad categories of concern: clinical validity, continuity of care, transparency and fairness, timely access and administrative efficiency, and alternatives and exemptions.

“Prior authorization practices can have a significant impact on pharmacists, their physician colleagues and the patients they serve, as well as impose significant administrative burdens,” said Mitch Rothholz, APhA Chief Strategy Officer. “APhA looks forward to working collaboratively with AMA and the rest of the coalition in an effort to produce a more efficient prior authorization process.