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State Design and Use of Prior Authorization Processes

This brief summarizes six state’s experiences in implementing and operating prior authorization (PA) processes that support a preferred drug list (PDL). The PA process can be divided into three major components: Submission, Review, and Appeal. This brief examines state policy choices and experience in each of these areas. It also examines two common means these states established for bypassing the PA process – emergency supplies and the Dispense as Written (DAW) provision.
David Bergman
Jack Hoadley, Jeffrey Crowley
March 2006
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medicaid_pa_pdl.pdf1.41 MB