Prior authorisation: difference between revisions
Diff·revision 9 → 10·15:07, 24 Mar 2025
Difference between revision 9 and revision 10 of Prior authorisation. 13 lines changed; the page grew by 844 bytes.
| Revision 9 — 15:19, 11 Mar 2025 TierTwoTansy (talk) space between number and unit per PP:MOS 2,250 bytes ±0 | Revision 10 — 15:07, 24 Mar 2025 Hedgerow_Hal (talk) rm the advice on how to obtain coverage 3,094 bytes +844 | ||
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| 1 | {{Infobox concept | 1 | {{Infobox concept |
| 2 | | name = Prior authorisation | 2 | | name = Prior authorisation |
| + | 3 | | subtitle = Insurance and coverage | |
| 3 | | Also called = Pre-authorisation, pre-approval | 4 | | Also called = Pre-authorisation, pre-approval |
| 4 | | Decided by = The payer, not the prescriber | 5 | | Decided by = The payer, not the prescriber |
| ⋮ | ⋮ | ||
| 19 | Reauthorisation is often required periodically, sometimes conditional on documented response such as a minimum weight reduction. A person who responds moderately may therefore lose coverage.{{r|kyle2021}} | 20 | Reauthorisation is often required periodically, sometimes conditional on documented response such as a minimum weight reduction. A person who responds moderately may therefore lose coverage.{{r|kyle2021}} |
| 20 | 21 | ||
| + | 22 | == Consequences == | |
| + | 23 | | Consequence | Direction | | |
| + | 24 | |---|---| | |
| + | 25 | | Delay to treatment | Days to months | | |
| + | 26 | | Administrative burden | Falls on prescribers and staff | | |
| + | 27 | | Denial despite clinical judgement | Occurs; appealable | | |
| + | 28 | | Discontinuation on coverage change | Common; see [[Weight regain after discontinuation]] | | |
| + | 29 | | Migration to unregulated supply | Documented in community reporting | | |
| + | 30 | ||
| + | 31 | The last row is where this intersects with the rest of the wiki. Where a licensed product is unaffordable or coverage is denied, some people obtain material outside licensed channels, with the identity, content and sterility uncertainties this wiki documents throughout.{{r|reports}} | |
| + | 32 | ||
| 21 | == References == | 33 | == References == |
| 22 | {{reflist}} | 34 | {{reflist}} |
| 23 | <ref name="ada2024">American Diabetes Association. "Standards of Care in Diabetes." ''Diabetes Care'' 47(Suppl 1) (2024).</ref> | 35 | <ref name="ada2024">American Diabetes Association. "Standards of Care in Diabetes." ''Diabetes Care'' 47(Suppl 1) (2024).</ref> |
| 24 | <ref name="kyle2021">Kyle TK, Stanford FC. "Moving toward health policy that respects both science and people living with obesity." ''Nursing Clinics of North America'' 56(4):635–645 (2021). PMID 34749900.</ref> | 36 | <ref name="kyle2021">Kyle TK, Stanford FC. "Moving toward health policy that respects both science and people living with obesity." ''Nursing Clinics of North America'' 56(4):635–645 (2021). PMID 34749900.</ref> |
| + | 37 | <ref name="reports">PeptidePedia Wiki community test-report tally, 2024–2026 (self-reported; see [[Project:Sourcing_guidelines]]).</ref> | |
| 25 | 38 | ||
| 26 | {{DEFAULTSORT:Prior authorisation}} | 39 | {{DEFAULTSORT:Prior authorisation}} |