Use of Prior Authorization Impacts 80 Percent of All Commercial Formulary Drugs According to BusinessOne Technologies

Payers Implementing More Restrictive Utilization Strategies for Drug Access

BENSALEM, Pa.--()--The percentage of drugs with prior authorization (PA) on at least one Commercial formulary has increased nearly 20 percent over the past nine years, impacting product performance and patient access, according to BusinessOne Technologies. From year end 2005 to November 2013, the percentage of Commercial formulary drugs with prior authorization increased from 61 percent to 80 percent. Formulary listings include brand-name drugs, generic drugs, blood glucose monitors, and test strips.

“The managed care landscape is becoming more complex to navigate, particularly with the increase in specialty pharmaceuticals, more competition and, as a result, more restrictions for access,” said James A. Barone, BusinessOne Technologies president and CEO. “We’ve seen a consistent increase in the use of prior authorization as a leading utilization management strategy. Payers will likely continue to increase the use of prior authorization across drug categories, and we are seeing the highest impact in the specialty category.”

Prior authorization is a clinical review designed to regulate the type of drug patients can receive under insurance coverage. These trends are driven by:

  • Growing competition across therapeutic categories, including oncology
  • Cost trends
  • The need to ensure appropriate use
  • Utilization drivers such as expanded indications, combination use, and new oral/self-injectable formulations
  • Therapeutic breakthroughs that require biomarker matching
  • Contracting opportunities with manufacturers for preferred status
  • Complex coverage policy requirements
  • An evolving focus on outcomes and pay-for-performance
  • Greater specialty drug alignment between the pharmacy and medical benefits

“With the right information, key stakeholders navigating this increasingly complex managed care landscape can ensure that patients are getting appropriate access to the medications they need,” Barone said.

About BusinessOne Technologies, Inc.

BusinessOne Technologies collects, integrates and analyzes data to provide creative solutions, competitive insights and strategic direction to pharmaceutical manufacturers who need current market intelligence to optimize product access and success, from pre-launch to post-marketing. BusinessOne delivers unique market perspectives through custom research, analytics and direct on-line access to integrated managed markets data, including formulary, drug coverage policy detail, benefit design, reimbursement, demographics and utilization at the plan and physician level. To learn more about BusinessOne Technologies, please visit www.businessonetech.com.

Contacts

BusinessOne Technologies, Inc.
William J. Gecawich
215-639-9345, ext. 106

Prior Authorization Trends: 2005-2013 (Graphic: Business Wire)

Prior Authorization Trends: 2005-2013 (Graphic: Business Wire)

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Release Summary

Use of prior authorization impacts 80 percent of all commercial formulary drugs, according to BusinessOne Technologies. Payers are implementing more restrictive utilization strategies for access.

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Contacts

BusinessOne Technologies, Inc.
William J. Gecawich
215-639-9345, ext. 106