Prior Authorization and Utilization Management Concepts in Managed Care Pharmacy
Prior Authorization and Utilization Management Concepts in Managed Care Pharmacy
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DOI：
10.18553/jmcp.2019.19069
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发表时间：
2019-06-01
影响因子：
2.1
通讯作者：
Wilkins, Tricia Lee
中科院分区：
文献类型：
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作者：
Ridderhoff, Kevin;Schuster, Ann M.;Wilkins, Tricia Lee
包括事先授权和使用管理的处方集被管理式医疗组织 (MCO) 广泛使用，包括健康计划和药品福利管理公司。使用管理标准对于优化患者治疗效果以及减少浪费、错误、不必要的药物使用和成本至关重要。管理护理药学学会 (AMCP) 专业实践委员会为 MCO 有效的事先授权实践制定了以下 9 个具体概念：(1) 患者安全和适当的药物使用，(2) 临床决策，(3) 循证审查标准，(4) 自动决策支持，(5) 透明度和提前通知，(6) 紧急访问，(7) 提供者合作，(8) 需要及时性和避免治疗中断，以及 (9) 成本效益和价值。 AMCP 支持这些概念，以允许处方者和付款人之间进一步合作，以确保患者能够适当且及时地获得药物、设备和其他治疗剂。版权所有 (C) 2019，管理护理药学学院。版权所有。
Formularies that include prior authorization and utilization management are widely used by managed care organizations (MCOs), including health plans and pharmacy benefit management companies. Utilization management criteria are essential to optimizing patient outcomes and reducing waste, error, unnecessary drug use, and cost. The Academy of Managed Care Pharmacy (AMCP) Professional Practice Committee has developed the following 9 specific concepts for effective prior authorization practices by MCOs: (1) patient safety and appropriate medication use, (2) clinical decision making, (3) evidence-based review criteria, (4) automated decision support, (5) transparency and advanced notice, (6) emergency access, (7) provider collaboration, (8) need for timeliness and avoiding disruptions in therapy, and (9) cost-effectiveness and value. AMCP supports these concepts to allow for further collaboration between prescribers and payers in order to ensure that patients receive appropriate and timely access to drugs, devices, and other therapeutic agents. Copyright (C) 2019, Academy of Managed Care Pharmacy. All rights reserved.