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Principles in Practice Prior Authorization Copyright © 2002 – 2005 – Academy of Managed Care Pharmacy (AMCP) Slide 1 Managed Care Organization Click here and overtype for title (MCO) • An organization with one or more products that integrate financing and management with the delivery of health care services to an enrolled population. Navarro RP. Managed Care Pharmacy Practice. Gaithersburg, MD: Aspen Publishers;1999. Copyright © 2002 – 2005 – Academy of Managed Care Pharmacy (AMCP) Slide 2 Pharmacy and Therapeutics (P&T) Click here and overtype for title Committee • The Pharmacy and Therapeutics Committee is a Committee of Health Care professionals responsible for the development and surveillance of all medication use policies and practices to assure optimum clinical results and a minimum potential for hazard to patients. The Pharmacy and Therapeutics Committee has three primary functions: – Formulary Maintenance – Safe Medication Use – Medication Use Evaluation Copyright © 2002 – 2005 – Academy of Managed Care Pharmacy (AMCP) Slide 3 Click here and overtype for title Formulary Management • An integrated patient care process that enables physicians, pharmacists and other healthcare professionals to work together to promote clinically sound, cost-effective pharmaceutical care. Academy of Managed Care Pharmacy. Concepts in Managed Care Pharmacy Series Pharmaceutical Care. 1997. Copyright © 2002 – 2005 – Academy of Managed Care Pharmacy (AMCP) Slide 4 Priorand Authorization Click here overtype for title • Protocols placed on medications to prevent their prescribing unless defined and specific criteria are met. Often, the agents subject to prior authorization are medications with a potential for misuse or inappropriate use. Navarro RP. Managed Care Pharmacy Practice. Gaithersburg, MD: Aspen Publishers;1999. Concepts in Managed Care Pharmacy Series, Prior Authorization and the Formulary Exception Process, Academy of Managed Care Pharmacy. Alexandria, VA: 2005 Copyright © 2002 – 2005 – Academy of Managed Care Pharmacy (AMCP) Slide 5 Click here Pharmacy and overtype for title On-Line Messaging • The process of electronically transmitting data to the point of prescribing subsequent to the creation of a prescription order or record for the purpose of providing the pharmacist with product coverage and safety information. Copyright © 2002 – 2005 – Academy of Managed Care Pharmacy (AMCP) Slide 6 Click here and overtype for title Clinical Practice Guidelines • A utilization and quality management mechanism designed to aid providers in making decisions about the most appropriate course of treatment for a specific clinical case. Copyright © 2002 – 2005 – Academy of Managed Care Pharmacy (AMCP) Slide 7