Report of Research on Pharmacy Benefit Managers’ Prior Authorization Denial Rates for Specialty Drug Prescriptions

Abstract

We conducted research on prior authorization, one of the most frequently used utilization-management programs for prescription drugs. We focused on 10 therapeutic drug classes that have specialty drugs.

The information we gathered from pharmacy benefit managers (PBMs) suggests there are no industry standards for prior authorization denials. Consequently, potential savings from prior authorization may depend on which PBM a plan sponsor uses.

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