Evaluating time to access opioid treatment for patients with insurance that requires the Safe & Effective Management of Pain prior authorization form vs others.

Abstract

In 2016, the Safe & Effective Management of Pain (SEMP) organization created guidelines regarding how to safely and effectively ensure patients were being treated with opioids. Two insurance companies in West Virginia used the SEMP guidelines to create a prior authorization (PA) form. This form requires extensive information about the patient to be submitted and then reviewed, including those with cancer or being treated with palliative intent. To evaluate the potential delay in accessing opioid prescriptions for patients with cancer or in palliative care who are required to use a specific PA form. This retrospective chart review used pharmacy claims for opioid prescriptions that were prescribed from the Edwards Cancer Institute and filled at Marshall Pharmacy beginning on January 1, 2022, to June 30, 2024. Prescriptions were stratified into 2 groups, those who had an approved claim by an SEMP-PA adherent insurance and those who were approved by another insurance that may or may not have required a different PA (non-SEMP). Turnaround time was evaluated from the moment the prescription was entered into Marshall Pharmacy's software to the moment it was ready to be dispensed to the patient. A total of 62 (45%) prescriptions were in the SEMP-PA group, and 77 (55%) did not require an SEMP-PA. The mean average turnaround time for the SEMP-PA group was 32.9 (SD = 67.6) hours and in the non-SEMP group was 6.23 (SD = 18.3) hours. The difference in turnaround time between both groups is 26.7 hours (<i>P</i> = 0.0012; 95% CI = 10.7-42.5). The SEMP-PA, after completion and approval, was associated with a significant increase in turnaround time for patients with cancer or for those being treated with palliative intent.