PM360 - First Fill Buy Downs

There is no question that prior authorization (PA) requirements around prescribed branded and specialty medications are a major hurdle for patients and healthcare providers (HCPs). This fact has been a concern for years and is only continuing to grow: 51% of physicians report that PAs have significantly expanded in the last five years.

According to a survey by the American Medical Association (AMA), the increase in PAs alone has led 92% of clinicians to report patient care delays. Further, 75% of prescribers indicate that the PA process has led to their patients abandoning treatment altogether.

At best, a delay in approval of even a few hours postpones access to treatment and increases the risk of abandonment. While many, including the AMA, are actively calling for the reformation of the PA system to help reduce administrative burdens on healthcare providers and decrease waiting time for patients, it would be ill-advised to assume this is a change that will happen any time soon, if ever.

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