Prior Medicaid Drug Authorization Endangers Patients

An overwhelming number of physicians say prior drug authorization may potentially lead to less than optimal treatment, more emergency room visits and it potentially places patients' lives at risk, according to survey (Harris Interactive) results announced today at the American College of Allergy, Asthma and Immunology (ACAAI) annual meeting. In addition, nearly 90 percent of the respondents from the general public say they prefer treatment decisions to stay with their physicians. And, in fact, these respondents cite their lack of trust in health plans or state Medicaid programs to choose the best medical course of action.

The survey, conducted on behalf of the ACAAI, is the first to examine the potential impact of limiting patient access to physician-recommended treatments by state legislatures and managed care organizations through a process called prior authorization. The process requires that these groups review medical treatments for coverage. Depending on the outcome of the review, treatments might have to obtain prior approval before an attending physician may prescribe it. The survey found that most physicians and members of the general public believe the practice of prior drug approval is seriously flawed.

Of particular concern among respondents are treatments for such urgent medical situations as an asthma attack, which require therapies called acute care or rescue medications. The largest group affected by prior approval for drug treatment is Medicaid recipients --which includes over 36 million people.

"For people with life-threatening diseases, like asthma, delaying prescribed treatment can have devastating consequences," states Bob Lanier, MD, president of ACAAI. "This is very clear to the medical community and population at large, as reported in this survey. This ought to be clear to the government, insurance companies or managed care organizations as well." The topic of prior drug approval, including those for emergency treatments, is being debated state by state.

Additional survey findings on physicians:* More than nine out of ten primary care physicians (92 percent) agree that "requiring prior authorization is bad policy for the simple reason that it takes the decision of what is the most appropriate medication for a patient in an emergency situation out of the hands of their physician -- the individual in the best possible position to determine what is best for a given patient in a given situation."

* Nearly all primary care physicians feel that prior authorization will have a negative impact on the overall health of patients who need acute care or rescue medications, and that patients won't have access to the best available treatment (92 and 95 percent, respectively).

* The majority of primary care physicians feel that prior authorization will have a substantial impact on the overall health of more acutely ill patients, low-income patients and elderly patients, with the greatest effect on the health of more acutely ill patients (67, 55, 49 and 54 percent, respectively).

* Nine out of ten primary care physicians (92 percent) also agree that "even if prior authorization might make sense for chronic condition medications, it doesn't make sense for "acute care or rescue" medications where many patients will not have such medication on hand when an emergency arises and will therefore have no time to seek prior authorization."

Additional findings on the general public:* Nine out of ten adults agree (90 percent) that "even if requiring prior authorization might make sense in non-emergency situations, it's hard to see how it makes sense when it discourages doctors who are dealing with a medical emergency from using the medicine they think is best." * Nine out of ten adults also agree (90 percent) that "prior authorization sounds like a bad idea because it will, in effect, take the decision of what medication is best for a patient out of the hands of the physician, who knows the patient best."

* Eight out of ten adults agree (82 percent) that "it's easy to imagine a physician -- faced with the requirement of prior authorization for the drug they think is best for their patient -- choosing to avoid the delay and hassle of getting approval and, instead, prescribing an alternative medication."

"A policy of prior authorization to use acute care or rescue medications is fool hardy and moreover, potentially deadly," claims Dr. Lanier. "Allergic asthma is a significant medical problem that demands serious attention by patients, employers, insurance companies, and state Medicaid programs."

The survey, conducted on behalf of ACAAI, includes responses from 315 primary care physicians and 2,464 adults over 18 years. The survey took place online from November 5 through November 6, 2002.

The ACAAI is a professional medical organization comprised of 4,200 qualified allergists-immunologists and related health care professionals. The College is dedicated to the clinical practice of allergy, asthma and immunology through education and research to promote the highest quality of patient care.

Interviews available upon request.

Survey and Medicaid fact sheets available.