Implementation of a Prior Authorization Process for Long-Acting Injectable (LAI) Initiative of HIV and PrEP Patients to Improve Financial Health of the Organization

Abstract Purpose: This quality improvement project established a streamlined pre-authorization process to enhance efficiency and reimbursement accuracy for initiating long-acting Injectable (LAI) therapy. It also focused on providing HIV and Pre-Exposure Prophylactic (PrEP) patients access to LAI close to home, with the ultimate goal of improving the financial health of a large LGBTQ organization. Background: The project was implemented in a primary care clinic located in Texas, serving a large population of patients with HIV and those within the LBGTQ community. Methodology: The project was designed and implemented following the Plan-Do-Study-Act Model for Improvement. Interventions were developed to create a standardized prior authorization and clinic workflow process. Data collection methods included quantitative analysis of preauthorization approval rates and qualitative assessment of staff feedback. Results: Post-implementation LAI patients decreased from 106 to 89, with Apretude dominant (51 patients vs. 38 Cabenuva)—successful funding enrollment for 100% of Apretude Buy and Bill patients. Improved workflow efficiency and increased staff engagement. Implications: Improved patient access to LAI medication led to better clinical outcomes and reduced HIV transmission rates, improved reimbursement accuracy and efficiency, and enhanced financial health. Increased staff engagement and participation, fostering a culture of continuous improvement. The potential for a future implementation project might be assessing stakeholders to foster a culture of openness, accountability, and shared responsibility for achieving positive outcomes in future quality improvement endeavors.