Clinical Services Team and 2 more...
% of pharmacy prior authorizations processed within 4 and 24 hours
Current Value
100.0%
Definition
Notes on Methodology
| # & % of pharmacy PAs processed | Oct 25 # | Oct 25 % | Nov 25 # | Nov 25 % | Dec 25 # | Dec 25 % | Jan 26 # | Jan 26 % | Feb 26 # | Feb 26 % | Mar 26 # | Mar 26 % | Apr 26# | Apr 26 % |
| Total PA Processed | 3040 | N/A | 2442 | N/A | 2689 | N/A | 2830 | N/A | 2830 | N/A | 2864 | N/A | 2731 | N/A |
| PA Processed in 24 hours | 3039 | 100.0% | 2441 | 100.0% | 2689 | 100.0% | 2827 | 99.9% | 2827 | 99.9% | 2860 | 99.9% | 2731 | 100.0% |
| PA Processed in 4 hours | 2883 | 94.8% | 2378 | 97.4% | 2668 | 99.2% | 2767 | 97.8% | 2767 | 97.8% | 2836 | 99.9% | 2665 | 97.6% |
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 because it allows the Pharmacy Unit to monitor that the Pharmacy Benefits Manager (PBM), Change Healthcare, is meeting the prior authorization (PA) turnaround time of 24-hours in accordance to their contract and CMS Federal requirement, Social Security Act 1927.
The performance measure represents the percentage of PAs turned around with a determination in 24-hour and 4-hour time frames. This is measured from the time a PA request is received in the Call Center until a PA determination is made, and a Notice of Decision is issued.
PAs completed within 24 hours from August to November and December 2025 are close to or at 100.0% for every month. The decrease in prior authorizations from October to November is associated with a reduction in member enrollment. The 4-hour window is more rigorous than the federal and contractual requirements, aiding in the assessment of the vendor’s performance and bolstering DVHA’s pharmacy PA program during discussions with providers and other stakeholders
Narrative last updated: 1/8/26
Partners
- Change Healthcare-Provider Call Center Staff
- DVHA’s Enrolled Prescribers and Pharmacies
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