The traditional model of prior authorization (PA) workflow is cumbersome and labor-intensive, with physicians themselves and their office staff coordinating with pharmacies and navigating the multistep PA process for medication approval. In Dermatology, the availability of medications comes with an unmanageable challenge of navigating ever-increasing PAs, but a new model initiated at Yale New Haven Hospital promises to alleviate that burden.
Jeffrey M. Cohen, MD, assistant professor of dermatology; and director, Psoriasis Treatment Program, was senior author on an article published in the International Journal of Dermatology, which presents a more collaborative and efficient alternative to the traditional model of PAs.
The new model provides patients with access to an additional member of the team with unique expertise. This not only optimizes the ability to access medication, but also creates more opportunities for patient education and enhanced monitoring.
Jeffrey M. Cohen, MD
In the traditional model, physicians’ offices would take ownership of sending prescriptions to pharmacies and coordinating the complex insurance and financial approval process required for specialty medication approval. Conversely, the collaborative model, or Medication Management Clinic (MMC), appoints an Ambulatory Care Pharmacist (ACP) to act as an intermediary between physicians and pharmacies. The ACP’s job is to assume responsibility of the PA workflow, as well as provide follow-up care and education for patients. In collaboration with Dermatology, the MMC services implemented at Yale New Haven Hospital (YNHH) were first implemented in November 2021, and, according to Dr. Cohen, have proven to benefit both physicians and patients.
“This novel approach to specialty medication management has been beneficial for patients, dermatologists, and pharmacists. The new model provides patients with access to an additional member of the team with unique expertise. This not only optimizes the ability to access medication, but also creates more opportunities for patient education and enhanced monitoring. For dermatologists and pharmacists, the model allows expert pharmacists to manage specialty medication approval and access while allowing each team member to utilize skills and knowledge to advance patient care.”
Cohen also notes that the MMC model has also been piloted by Digestives Diseases and Rheumatology at Yale New Haven Hospital. Given the MMC model’s success in multiple disciplines, there is potential for more widespread use, but Yale New Haven Hospital remains the only institution in the United States to use it.
“This model has been very successful in [Dermatology] and is something that is widely applicable. While there are multiple strategies for managing the complexities of specialty medication access, our approach has managed to do that while providing patients with more contact with the healthcare team. Ultimately, this novel approach has not only been able to reduce an important barrier to care but has also enhanced patient care and improved patient experience.”
The MMC model produces the dual effects of decreasing the burden placed on physicians’ offices and improving medication access for patients at YNHH. Only time and additional data will tell how well it can be applied to other health systems in the U.S. and beyond.