Drug Information Group-Now the Medicaid Prior Approval Unit for State of Illinois
December 04, 2007
The University of Illinois at Chicago College of Pharmacy and the state of Illinois are collaborating to provide a timely and cost-effective approach to prior authorization for prescription drugs to eligible Health and Family Services (HFS) Medical Program patients, including Medicaid.
Some prescription drugs and over-the-counter products require prior authorization before reimbursement will be provided by the Illinois Medicaid program. Under a three-year contract with the Illinois Department of Healthcare and Family Services (HFS), UIC’s Drug Information Group reviews nearly 1,200 requests for prior authorization daily. Each of these requests are reviewed and evaluated before a prescription is filled.
“With HFS Medical Programs there are issues related to safety of the medications as well as cost benefit,” said Mary Lynn Moody, Clinical Assistant Professor and Business Director of the Group. “If a patient can not tolerate the side effects of a drug, they need to try something else. We want to protect patients while giving them a choice.”
The preferred drug list contains more than 66 drug classes. Most medications on the preferred drug list are covered without prior authorization when prescribed at doses within normal ranges and corresponding quantities, Moody said.
The Drug Information Group initially partnered with the Illinois Department of Healthcare and Family Services in 2004 to conduct drug therapeutic class reviews for the preferred drug list. The state agency uses the reviews as a resource for the Drug and Therapeutics Committee when determining the HFS Medical Programs Preferred Drug List, Moody said.
The partnership was expanded to utilize the expertise of clinical pharmacists and physicians from UIC in the prior authorization process, she said. The Drug Information Group consists of eight full-time pharmacists, a director, an assistant director, and a full-time medical director from the University of Illinois Medical Center at Chicago,
“We’ve already realized opportunities to improve drug therapy and assist physicians,” Moody said. “Our response times have improved dramatically, and the pharmacists and physicians are extremely pleased with the clinical information we are able to provide them. It’s been a great working relationship.”
Jerry Bauman, dean of UIC’s College of Pharmacy, said the partnership between the state and the Drug Information Group is a “win-win” situation for everyone involved.
“This is a wonderful example of how the state of Illinois can partner effectively with the University of Illinois,” Bauman said. “The state can use the expertise of our faculty in making sometimes difficult decisions on drug therapy for the Medicaid population and we can build an environment suitable for training our students in real-world situations.”
For more information about HFS Medical Programs Drug Prior Authorization, visit: www.ilpriorauth.com.