Access and Utilization of New Antidepressant and Antipsychotic Medications. C. Prior Authorization


The provider and consumer associations interviewed reported that formularies are no longer impeding access to newer medications. This view has been confirmed by the research presented above. These groups felt that prior authorization and paperwork requirements were now the primary barrier to access. The four associations interviewed reported that prior authorization is required more for mental health pharmaceuticals than other drugs. It is unclear the degree to which PA requirements are proving unduly burdensome. Our research shows that PA is becoming increasingly automated and that this trend is adding efficiency to the process.

The pharmaceutical manufacturers interviewed disagreed as to whether PA is required more or less for psychotherapeutics than for other drugs. They agreed that antipsychotics no longer require prior authorization as a matter of policy (e.g., Medicaid, VA, MCO). However there are some restrictions at the facility (community) level. PA may be more common for antidepressants. In the public sector, manufacturers attempt to overcome the budgetary reasons for PA in different ways. For example, Government Affairs departments may work with government officials to expand the overall mental health budget in order to expand access to their newer psychotherapeutics. In the private sector, manufacturers' reimbursement department may discuss drug products with CEOs of health plans to demonstrate value.