Who is responsible? A risk-stratified framework for pharmacist accountability in artificial intelligence-assisted managed care.
TL;DR
A pharmacist-centered accountability framework for AI-assisted managed care decisions is proposed that emphasizes explicit professional responsibility, structured human-in-the-loop review, and documentation practices that support transparency and auditability.
Abstract
Artificial intelligence (AI)-enabled tools are increasingly integrated into managed care pharmacy workflows, particularly in utilization management and prior authorization processes. Although these systems aim to improve operational consistency and efficiency, federal regulatory guidance and professional standards make clear that coverage and medical necessity determinations must remain grounded in human clinical judgment. As AI tools become part of routine managed care, responsibility for final decisions may become unclear, creating an accountability gap. This article synthesizes federal regulatory guidance and professional pharmacy standards relevant to AI use in health care. We review Centers for Medicare & Medicaid Services requirements, oversight findings from the US Department of Health and Human Services Office of Inspector General, and established pharmacy ethics frameworks. Based on this review, we propose a pharmacist-centered accountability framework for AI-assisted managed care decisions. The framework emphasizes explicit professional responsibility, structured human-in-the-loop review, and documentation practices that support transparency and auditability. Clarifying pharmacist accountability in AI-assisted utilization management can strengthen professional stewardship, enhance workforce readiness, and support responsible innovation in managed care pharmacy.