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DVHA says prior-authorization requirements cut after review; pharmacy PAs dropped 43% from prior year
Summary
DVHA staff told the House Appropriations Committee that a four‑year review prompted removal of many prior authorization requirements for Medicaid services; total prior authorizations fell to about 17,000 in FY24, a roughly 43% decline from the prior year, agency witnesses said.
Department of Vermont Health Access officials told the House Appropriations Committee on Feb. 12 that the agency removed a number of prior authorization (PA) requirements after a multi-year review and a pandemic-era suspension showed no systemic misuse.
Sandy Hoffman, deputy commissioner of the Department of Vermont Health Access, said the agency reviewed four years of data and concluded many prior authorizations could be eliminated while retaining medical-necessity documentation requirements. “We removed the requirements for prior authorization before getting the service,” Hoffman…
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