aceA pharmacist-overseen, artificial intelligence-enabled model for provider-side prior authorization: From burden to opportunity (PAVE-1)
Prior authorization (PA) imposes substantial administrative burdens on clinicians, contributing to burnout, delayed care, and excess health care spending. Artificial intelligence (AI) is emerging as a tool to automate PA tasks in managed care pharmacy, yet concerns persist regarding transparency, bias, and overreliance on autonomous systems. This is particularly true in payer-deployed AI systems that may deny claims without adequate clinical review. This viewpoint proposes a pharmacist-overseen, AI-enabled syste…
A pharmacist-overseen AI system for provider organizations could reduce prescriber workload and increase first-pass approval rates by automating routine data extraction and submissions while routing complex cases to pharmacists.
Use of AI to automate prior authorization raises concerns about transparency, bias, and overreliance, with payer-deployed systems potentially denying claims without adequate clinical review.
Viewpoint is conceptual and untested; benefits are presented as potential and authors note need for further research and collaborative implementation.
Evidence
- Peer-reviewedJournal of Managed Care & Specialty Pharmacy2026-09-01
How should this claim be treated?
Truvace Impact Record TRV-2026-0956, v1: “A pharmacist-overseen, artificial intelligence-enabled model for provider-side prior authorization: From burden to opportunity (PAVE-1).” Truvace, 2026-09-01. /record/TRV-2026-0956 (accessed at citation time). sha256 5dc9b23e4686ea64…
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