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Utilizing Prior Authorization Programs Prior Authorization Programs have been shown to significantly impact utilization patterns. The goal of a PA program is to provide efficient, cost effective, quality health care to the recipients by ensuring that drugs are used by evidence based rules and the FDA approved Package Labeling. By implementing a PA program, clients do not pay for unproven, inappropriate therapies. However, because evidence based rules are used to determine appropriateness of therapy, no patient with genuine need would “go without” the medicine he needs. HID’s prior authorization programs identify drugs or classes
of drugs that should require a PA to ensure that the drugs are being
prescribed appropriately and in accordance with the FDA approved
labeling. HID also ensures that the patient for whom the drugs are
being prescribed has failed other alternative therapies that could
be used to treat the diagnosis of the patient.
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