A study by the Journal of Managed Care & Specialty Pharmacy (JMCP) analyzed data from the Veterans Affairs (VA) Healthcare System and found that optimization reviews, or “prior authorization” was responsible for preventing adverse drug events ranging from minor to catastrophic.
More than 10 percent of the prior authorizations reviewed by the study uncovered potential medication errors that could have harmed veteran patients.
Of those, nearly 70 percent of the cases where prior authorization stopped these errors were classified as either major or catastrophic.
The study defines major as an event that “results in a serious patient outcome” such as a “life-threatening condition, hospitalization, or increased length of stay.”
Catastrophic was defined as an event that results in “death or permanent loss of function, disability, or congenital anomaly.”
One case highlighted in the study focused on a veteran with stage IV breast cancer. The patient was prescribed a medication to help with the cancer. Under a prior authorization review, however, it was found that this specific patient also had an underlying condition that resulted in low white blood-cell counts. The medication prescribed to help with the breast cancer is known to worsen the underlying white blood-cell issue, which would have left the patient more suspectable to viruses and infections.
This major event was prevented because of a prior authorization safety review.
It is often easy to think of prior authorizations as a nuisance, or Medicare or your insurer getting between you and your doctor.
But the truth is that prior authorizations are a critical tool to help ensure patient safety.
And as the VA study shows, in some cases, it can be the difference between life and death.
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