Utilization management is a process used by payers to make sure that only patients meeting appropriate criteria are given a specific medication or procedure. The two most common forms of utilization management are prior authorization and fail-first policies. Thee can be to ensure patient safety when a drug or procedure is contraindicated for a class of patients, to limit use of a medication to only patients who have not seen results from another medication.
Report a Payer Issue to ASAM
Use this form to report issues with payers related to utilization management, parity or other areas.
AMA Prior Authorization Toolkit
These resources from the AMA include tips to make the prior authorization process easier for physicians and staff.
ASAM Approved Prior Authorization Form for Buprenorphine
This form can be used when advocating with insurers about prior authorization process for buprenorphine.