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Below is the HillCo client report from the August 8 Standardized Prior Authorization Form for Prescription Services Advisory Committee meeting.
 
The advisory committee met to discuss the content of the standardized PA form. A draft form was presented at the meeting (attached).  Committee members made comments regarding each section based on their opinion of what should be added or removed from the form.
 
Section1 – Submission

  • A checkbox should be included to indicate urgency or emergency situations
    • Do not want  to create a situation where doctors check the “urgent” box every time because it is easy
    • May want to add some type of attestation or simple disclaimer to the form to show the reason for the indication
    • Could require doctor’s initials to indicate they read the disclaimer
    • Could make the box say “life threatening”
      • Shouldn’t do that because there are a lot of other urgent situations where time can make a difference that aren’t life threatening
  • The form should be created keeping in mind that all of these forms will be electronic in the near future; do not want to have to do work twice

 
Section 2 – Patient Information

  • May want to add an “other” box in the gender section instead of having it say ”unknown”
  • May want to include additional patient phone number fields; many times health plans use the phone number to identify a patient and they have multiple they can use; would be better to have more to prevent call backs
  • There was discussion about having fields on the form that are not required; many health plan representatives noted that they would like to have more information even if it is not required because it is helpful; doctors noted that if the information is not required they are likely not to fill it out
    • May want to mark some fields “if available” so that it doesn’t say “not required” but it is known that if they do not have the information they do not have to go search for it

 
Section 3 – Prescriber Information

  • There was discussion about the field marked “specialty”; can cause confusion in situations where a doctor has multiple or it could be confusing when getting into sub-specialties

 
Section 4 – Prescription Drug Information

  • May want a checkbox that says “brand medically necessary” or “brand requested” by the “requested drug name” field
    • It won’t make much of a difference, doctors will put what drug they want to prescribe in the existing field
  • There was concern about the “strength”, “frequency” and “quantity” fields; may not be enough information to show titration
    • Titration can be addressed in the section for notes
  • It may need to say “dose” instead of “strength”
  • “Frequency” is not important; the only necessary fields are “quantity”, “strength” and “days’ supply”; those three fields would cover titration as well
  • “Date started” is important because some drugs are only covered by plans for a certain period of time; if a patient has already been on a certain drug for two months and it is a three month drug, the plan would only want to authorize for an additional month

 
Section 5 – Patient Clinical Information

  • May want to add “comorbidities” or “contraindications” in this section next to drug allergies
  • The “ICD version” field is unnecessary
  • May want to add a field for “relevant lab values”

 
Back Page

  • Need to make the “drug allergy” section larger and move it to the back page so there is enough room to explain comorbidities and contraindications
  • May want to add fields for “signature” and “date”
    • That could create a problem when sending electronically; an e-signature should be fine
      • There may be rules that require an actual signature

 
 
Staff will take the recommendations made at the meeting and update the draft PA form. It will then be brought back to the committee for more work at the next meeting.
 

Attachments