Segal Research on Prior Authorization of Prescriptions for Specialty Drugs

Segal conducted research on prior authorization, one of the most frequently used utilization-management programs for prescription drugs. We looked at 10 therapeutic drug classes that have high-cost specialty drugs. We gathered information from pharmacy benefit managers (PBMs).

Our research suggests there are no industry standards for prior authorization denials. Consequently, potential savings may depend on which PBM a plan sponsor uses.

See our report, which shows the range of prior authorization denial rates by therapeutic class. We rate PBMs’ prior authorization denial rates as high, medium or low.

Segal conducted research on prior authorization, one of the most frequently used utilization-management programs for prescription drugs. We looked at 10 therapeutic drug classes that have high-cost specialty drugs. We gathered information from pharmacy benefit managers (PBMs).

Our research suggests there are no industry standards for prior authorization denials. Consequently, potential savings may depend on which PBM a plan sponsor uses.

See our report, which shows the range of prior authorization denial rates by therapeutic class. We rate PBMs’ prior authorization denial rates as high, medium or low.

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Eileen O. Pincay, RPh

Eileen O. Pincay, RPh

VP and Senior Pharmacy Consultant