Pharmaceutical Prior Authorization (PPA)
- Purpose: Evaluate the appropriateness of future prescriptions for "red- flagged" medications (including compounds) to comply with agreed-upon triggers and protocols for medications, questions related to appropriate dosages, weaning recommendations
- Scope:
- Review of a single drug in the overall pain management regimen
- Reviewer: Active practice MD
- Inputs:
- Medical records (no limit)
- RX scripts and bills associated with this single drug
- Other reviews like DUR
- Peer-to-peer discussion
- Evidence Based Medicine
- Reviewer’s active clinical and academic experience
- Latest medical research
- Discussion: Unless otherwise stipulated by the customer, the prescribing physician will be contacted and receive a copy of the report
Therapeutic Equivalent Conversion: Embedded in both products, this is the evaluation of each medication for conversion to generic or therapeutic (alternative) equivalent, and where allowed by Jurisdiction the recommendations can be mandated changes
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