CTC-RI provides recommendations to OHIC for improving prior authorization process

  • 06 Nov 2023

The CTC-RI Prior Authorization Committee submitted its final recommendations report to OHIC for consideration as it reconvenes its Administrative Simplification Committee. The report is a culmination of months of work by committee members who represent health insurance companies, pharmacists, and health care organizations from across Rhode Island. The six recommendations are:

  1. Reduce the prior authorization volume
  2. Improve the data collection on prior authorization
  3. Create ongoing statewide advisory committees
  4. Evaluate therapeutic substitution at the pharmacy
  5. Implement technologies that improve the process
  6. Identify and reduce processes that are “PA-like”

The Prior Authorization Committee was convened in April 2023 at the request of OHIC to develop concrete consensus recommendations that take into account health plans/payers, providers and patients’ needs for a more effective, less burdensome and resource-intensive prior approval process, ultimately supporting evidence-based, affordable, high-quality care and reducing unnecessary/unsafe service and medication utilization.