Perceptions of Saskatchewan Community Pharmacists Regarding a Prior-Authorization Program

BACKGROUND: In 1999, Saskatchewan Health authorized pharmacists to initiate exception drug status (EdS) requests, also known as prior authorization (Pa). Before 1999, only those licensed to prescribe medications were authorized to initiate EdS requests. A pharmacist who submits an EdS request must obtain a patient diagnosis from the physician or agent of the physician; a diagnosis presented by the patient is insufficient. OBJECTIVES: to obtain pharmacists' opinions about the benefits of the Pa program of the Saskatchewan drug Plan and to identify factors associated with pharmacist-initiated EdS requests. METHODS: a census survey of community pharmacy managers was conducted via a self-administered postal questionnaire in the province of Saskatchewan, Canada, in the fall of 2004. The survey questionnaire was addressed to pharmacy managers, some of whom may have delegated the response to a staff pharmacist. Pharmacy managers or their delegates were asked to respond on behalf of all pharmacists in their pharmacies. RESULTS: a response rate of 82.6% was achieved (275/333). A majority of respondents agreed that the province's Pa program (EdS) benefited patients (87.3%) and the Saskatchewan drug Plan (82.5%), whereas only 33.4% of respondents agreed that the EdS program benefited pharmacists. Pharmacists' ability to obtain the requisite information (87.6%) and to contact the prescribing physician (87.3%), as well as patient-centered concerns such as the patient's ability to pay for the prescription (85.1%), were the most important factors. the time required by the pharmacist to initiate the request was not important relative to other factors. Community pharmacies reported receipt of an average of 36.4 prescriptions for restricted and nonformulary drugs per week, of which 22 were submitted for Pa coverage, 17 by the pharmacy and 5 by the pharmacy at the request of the physician. CONCLUSIONS: the results of this study indicate that community pharmacists in Saskatchewan acknowledge that the EdS process is beneficial for their patients. However, pharmacists are burdened by an administrative process in which necessary information, particularly the patient diagnosis, is not readily available.