Discussion: The Application of Data to Problem-Solving

Discussion: The Application of Data to Problem-Solving

You raise some excellent concerns about noncompliance in behavioral health patients.  One simple solution to help these patients receive better care would be to take insurance prior authorization for medications out of the healthcare system.  Some medications require authorization from an insurance company prior to being filled by a pharmacy.  For patients without insurance, these medications can be paid for out of pocket.  For patients without insurance, pharmacies will frequently refuse to fill the prescriptions and allow patients to pay out of pocket for them while prior authorization is actively in process.  According to Jones et al. (2019), antidepressants, narcotic analgesics, and hypnotics are among the most frequently prescribed medications which require prior authorization when prescribed.  Many of these medications are frequently used in the behavioral health settings. Blake et al. (2019) describes a study involving pediatric patient in which the process of obtaining prior authorization created barriers in continuity and quality of care.  Another study of dermatology patients found prior authorizations cause a huge burden on providers and lead to delayed, lesser, or abandoned treatment (Petitt et al., 2021).

References

Blake, S. C., Song, M., Gaydos, L., & Cummings, J. R. (2019). Prior Authorization Policies and Preferred Drug Lists in Medicaid Plans: Stakeholder Perspectives on the Implications for Youth with ADHD. Administration and Policy in Mental Health, 46(5), 580–595. https://doi-org.ezp.waldenulibrary.org/10.1007/s10488-019-00937-y

Jones, L. K., Ladd, I. G., Gregor, C., Evans, M. A., Graham, J., & Gionfriddo, M. R. (2019). Understanding the medication prior-authorization process: A case study of patients and clinical staff from a large rural integrated health delivery system. American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, 76(7), 453–459. https://doi-org.ezp.waldenulibrary.org/10.1093/ajhp/zxy083