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Clinical Services Team

Dept. of Vermont Health Access

% of pharmacy prior authorizations processed within 4 and 24 hours

Current Value

99.9%

Jul 2026

Definition

Notes on Methodology

# & % of pharmacy PAs processed Jan 26 # Jan 26 % Feb 26 # Feb 26 % Mar 26 # Mar 26 % Apr 26# Apr 26 % May 26 # May 26 % Jun 26 # Jun 26 % Jul 26 # Jul 26 %
Total PA Processed 2830 N/A 2830 N/A 2864 N/A 2731 N/A 2585 N/A 2644 N/A 2674 N/A
PA Processed in 24 hours 2827 99.9% 2827 99.9% 2860 99.9% 2731 100.0% 2583 99.9% 2640 99.9% 2672 99.9%
PA Processed in 4 hours 2767 97.8% 2767 97.8% 2836 99.9% 2665 97.6% 2547 98.5% 2535 95.9% 2542 95.1%

Please note that in the chart above:

  • The dotted trendline represents the % of PA processed in 4 hours or less
  • The solid bar represents the % of PA processed in 24 hours or less

 

Story Behind the Curve

This performance measure is important since it allows the Pharmacy Unit to verify that the Pharmacy Benefits Administrator (PBA), Change Healthcare/Optum Rx, is achieving the required 24-hour prior authorization (PA) turnaround time in line with their contractual obligations and the CMS Federal requirement, Social Security Act 1927.


The performance measure metric indicates the percentage of PAs  processed with a determination within 24-hour and 4-hour intervals. This is measured from the moment a PA request is received in the Call Center until a determination is made and a Notice of Decision is sent out. The completion rate of PAs within 24 hours from February through July 2026 is close to or at 100.0% for each month.

The 4-hour timeframe is stricter than the federal and contractual standards, facilitating the evaluation of the vendor’s performance and strengthening DVHA’s Pharmacy PA program in conversations with providers and other stakeholders.

Narrative last updated: 07/15/2026

Partners

  • Optum-Provider Call Center Staff
  • DVHA’s Enrolled Prescribers and Pharmacies