Prior authorization policies linked to 2-week delay in anticancer-drug prescription fills
Click Here to Manage Email Alerts
Key takeaways:
- After a new prior authorization policy, fills of a 30-day prescription did not occur until day 49.2.
- Overall, prescriptions fills were delayed a mean 13.7 days in the period after vs. before policy change.
New prior authorization policies appeared associated with about a 2-week delay in oral oncology drug prescription fills, according to study results presented during ASCO Annual Meeting.
The findings indicate that further research is needed to identify opportunities to reduce administrative burden of prior authorizations and barriers in access to effective cancer therapies, researchers concluded.
Rationale and methods
“My broad area of focus is nonfinancial costs of care and administrative burden, especially from the patient’s perspective. Prior authorizations came to my attention in past studies, which is what prompted me to explore this issue in claims data,” Michael Anne Kyle, PhD, RN, research fellow in the department of health care policy at Harvard Medical School, told Healio.
Cost and quality are persistent challenges in the U.S. health care system, Kyle said during her presentation.
“High costs of care affect access and utilization, and quality of care also remains uneven, with challenges in both over- and undertreatment,” she said. “Prior authorization is a nonprice mechanism for influencing utilization, and in oncology care, prior authorization is a tremendous issue for physicians.”
Kyle and colleagues assessed prior authorizations for multiple FDA-approved oral anticancer agents among 2,604 Medicare Part D beneficiaries and their impact on delays in prescription fills.
The researchers looked specifically at those who had been enrolled in the same plan for at least 4 months before the index date (Jan. 1) and had at least three 30-day fills during that time. They compared predicted vs. actual time to first prescription fill among enrollees in a plan that had a new prior authorization policy on the beneficiary’s oral anticancer therapy and a control group that had no new prior authorization policy.
Time to next fill after prior authorization policy change served as the outcome variable of the difference-in-difference study. The investigators controlled for age, sex, race, Medicaid enrollment, average number of days between pre-period prescription fills, year of prescription fill and plan type (standalone plan vs. Medicare Advantage), beneficiary residential ZIP code percentage below federal poverty level, and educational attainment.
Findings
Results showed comparable discontinuations for the new prior authorization group (8.7%) and the control group (8.9%).
“On the one hand, that’s heartening ... but remember that I’m looking only at people who have been on this drug, so they’ve already established that they’re taking it,” Kyle said.
Prior to the index date, the new prior authorization group filled a 30-day prescription at 38.1 days, about 8 days late. The control group had a similar number of days to next fill (38.4).
After the index date, researchers found the control group filled their prescriptions about 2.7 days earlier, but the new prior authorization group did not fill until day 49.2, about 11 days later than the previous period (difference-in-difference, 13.7 days; 95% CI, 11.3-16.2).
Researchers observed the longest delay in days to next fill for imatinib (21.5 days).
“We also observed covariates associated with longer delays, including nonwhite race, with Black individuals having experienced longer delays than other races,” Kyle said.
Study limitations included the fact that researchers only evaluated Medicare beneficiaries and examined only 10 drugs for prior authorizations.
Implications
Anecdotally, patients and oncologists have described delays associated with prior authorization, which these findings support, Kyle told Healio.
“This work finds no difference in discontinuation, which suggests that the effect of the new prior authorizations policy is a 2-week delay for a patient already stable on the drug without a change in utilization, suggesting that care is delayed unnecessarily,” she said.
Collapse
Kyle MA, et al. Abstract 1504. Presented at: ASCO Annual Meeting; June 2-6, 2023; Chicago.
Read more about
Click Here to Manage Email Alerts