THOUGHT PIECE: Evolution of the PA: Where We Are and Where We Are Heading

Abstract: Over time, US payers have increased their influence on physicians’ treatment selection process across many therapeutic areas.  One of the primary means for US payer intervention is the prior authorization (PA), which is often implemented under the guise of clinical appropriateness, although true motivations are primarily financial.  Given the growing emphasis of ‘value’ in healthcare and the near-automatic implementation of PAs in the specialty pharmaceutical arena, it is a meaningful exercise to explore the motivations, approaches, and consequences of this process across the US payer landscape.  As payer approaches and healthcare infrastructure (including electronic prescribing) evolve, it is also important to speculate on the future of the PA system in the US.

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