Prior authorization to improve testing of glycosylated hemoglobin in a managed care setting

Objective: To ascertain whether revocation of a prior authorization (PA) requirement by the Leumit Health Fund of Israel resulted in inferior rates of glycosylated hemoglobin (A1C) testing among new users of expensive diabetes medications. Study Design: Electronic patient record (EPR) database study. Methods: Data on new users of the target drugs and on A1C testing in these patients were extracted from EPR databases for the 6-month period after the revocation.The proportion (95% confidence interval [Cl]) of patients who obtained at least 1 A1C test during the 4 months before initiation of treatment was calculated.The data were stratified by month to detect possible trends in rates of testing during the period after the policy change. Results: After the PA requirement was rescinded, A1C testing among incident users of the target drugs dropped from 100% during the PA period to rates ranging from 85.6% (95% Cl,79.7%-91.5%) to 94.4% (95% Cl, 90.8%-97.9%). Statistically significant variance in monthly rates of testing was not observed. Conclusions: Prior authorization has been successfully implemented in the managed care setting studied to obtain 100% performance of a laboratory test necessary to monitor drug therapy outcomes in patients with diabetes mellitus. When PA is implemented as a quality assurance strategy, its revocation should be accompanied by continuing education efforts designed to maintain optimal adherence to recommendations for appropriate care.