Prior Authorization Criteria: Looking Beyond Clinical Trial Populations

Pricing: Free for Members and $30 for Non-Members

Course Description

New medications often require prior authorizations (PA), but how is PA criteria determined? Most PA criteria is based on the clinical trial, using specific numerical values to determine effectiveness. Many often take for granted the complexities of assigning this PA criteria, hence the importance of understanding the ‘why’ and taking into consideration the inclusion and exclusion criteria from the clinical trials.

This session will discuss relatively new medications and common PA criteria often used as faculty explore criteria based on pivotal trial populations/outcomes compared to potential patient benefit. Faculty will share real-life examples and research results.

Target Audience

Pharmacists who practice in managed care settings.

Learning Objectives

At the completion of this activity, participants should be able to:

  1. Determine inclusion/exclusion criteria developed for the benefit of a pivotal trial itself.
  2. Recognize the differences between trial-focused and patient-focused baseline and outcome data employed in prior authorization criteria.
  3. Explain how to use a patient-focused approach to develop prior authorization criteria.
Course summary
Available credit: 
  • 1.25 ACPE
    ACPE The Academy of Managed Care Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
  • 1.25 Certificate of Completion
Course opens: 
05/17/2023
Course expires: 
12/31/2024
Cost:
$30.00

Faculty

Heather Odem, PharmD
Director of Pharmacy
UnitedHealthcare Community & State- Mississippi
Ridgeland, MS


Richard Ogletree, PharmD
Pharmacy Director
Alliant Health Solutions
Ridgeland, MS

Moderator

Gene Reeder, RPh, PhD
Professor and Director of Outcomes Research
University of South Carolina College of Pharmacy
Columbia, South Carolina

Financial Relationship Disclosures

Faculty/Reviewer/PlannerReported Relevant Financial Relationships
Heather Odem
Faculty		Disclosed no relevant financial relationships.
Richard Ogletree
Faculty		Disclosed no relevant financial relationships.

YuQian Liu
Reviewer

Employee: Magellan Rx Management

Brittany V. Henry
Planner		Disclosed no relevant financial relationships.
  • AMCP Staff have disclosed no relevant financial relationships.
  • If applicable, relevant financial relationships have been mitigated and documented.
  • Content has undergone a peer review to ensure content validity.

Accreditation:

The Academy of Managed Care Pharmacy (AMCP) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

ACPE UAN:0233-0000-22-032-H03-P • Activity Type: Knowledge-Based
Contact Hours: 1.25
Release Date: March 22, 2023 •  Expiration Date: December 31, 2024
Activity Fee: Free for Members and $30 for Non-Members

Participants should claim continuing pharmacy education (CPE) credit for this home study activity only if they have not claimed credit for the live activity presented at AMCP 2023. CPE credit will be processed through the AMCP Learn portal and reported directly to CPE Monitor. Please allow 72 hours for processing and posting in your NABP account.

To receive credit for an online activity you must:

  • Review the full content of the activity.
  • Successfully complete the post-test (required to pass with a score of 70% or higher, it may be taken a maximum of three times).
  • Complete a specific activity evaluation.

Available Credit

  • 1.25 ACPE
    ACPE The Academy of Managed Care Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
  • 1.25 Certificate of Completion

Price

Cost:
$30.00
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Required Hardware/software

System Requirements Courses and learning activities are delivered via your Web browser and Acrobat PDF. For all activities, you should have a basic comfort level using a computer and navigating websites. View the minimum technical and system requirements for continuing education online learning activities