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