Compliance

Background If the plan is considering allowing members who obtain specialty medications through a carve-out international sourcing program to bypass the Group Health Plan’s (GHP) prior authorization (PA) requirements, these considerations should be carefully weighed. Importantly, the medication would remain covered under the GHP and would still require PA if obtained through the plan’s traditional pharmacy benefit. The proposed change would create two access pathways for the same medication: The primary concern is not whether…