View the Latest: Prior Authorization
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CMS Prior Authorization Proposal Aims to Streamline the Process and Improve Transparency
Issue BriefThis brief explains a new proposed federal regulation aimed at reducing administrative hassles involved in obtaining prior authorization for care and sets out key policy questions, including how the proposal could impact the patient experience and data privacy.
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Medicare Advantage Plans Denied 2 Million Prior Authorization Requests in 2021, About 6% of Such Requests
News ReleaseMedicare Advantage plans denied two million prior authorization requests for health care services in whole or in part in 2021, or about six percent of the 35 million requests submitted on behalf of enrollees that year, a new KFF analysis finds.
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Prior to Authorization, Three in Ten Parents Would Get Their 12-15 Year Old Child Vaccinated Against COVID-19 ASAP
FeatureBefore the FDA expanded the Pfizer-BioNTech COVID-19 vaccine emergency use authorization for 12 to 15 year olds this week, the latest KFF COVID-19 Vaccine Monitor reported that 30 percent of parents of children ages 12 to 15 said they would get their child vaccinated right away.
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Differences in Prior Authorization Rules in State Medicaid MCO and FFS Pharmacy Benefit
State Health Facts Indicator -
Prior Authorization in Medicare Advantage Plans: How Often Is It Used?
Issue BriefMedicare Advantage enrollees are encouraged to select their plan based on a number of factors, including premiums, cost-sharing, extra benefits, drug coverage, quality of care, and provider networks, but a potentially overlooked factor is access to covered services and the potential impact of prior authorization requirements. In this data note, we examine the share of Medicare Advantage enrollees that are in plans requiring prior authorization and approval before covering the costs of services.
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Medicare Part D 2008 Data Spotlight: Utilization Management
Issue BriefThis Medicare Part D data spotlight examines three common techniques used by Medicare stand-alone prescription drug plans in 2008 to manage enrollees’ use of formulary drugs, such as quantity limits, prior authorization, and step therapy rules. This is one in a series analyzing key aspects of the 2008 Medicare Part D prescription drug plan choices.
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Model Prescription Drug Prior Authorization Process for State Medicaid Programs
ReportThis report details the rules governing prior authorization programs and the major steps in a model process based on key issues raised by beneficiary advocates, provider groups and states.
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Prior Authorization for Medicaid Prescription Drugs in Five States: Lessons for Policy Makers
ReportThis report is a case study of five states' (California, Georgia, Oklahoma, Oregon, and Washington) implementation of prior authorization in their Medicaid programs.
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Case Study: Michigan’s Medicaid Prescription Drug Benefit
ReportCase Study: Michigan's Medicaid Prescription Drug Benefit This report describes the legislative process behind and content of Michigan's Pharmaceutical Product List (MPPL), a selection of preferred drugs available to be prescribed in the Medicaid program with little restriction.