Prior authorizations for anti-VEGFs cause treatment delays, administrative burdens
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Key takeaways:
- The prior authorization process resulted in a delay of care for 59.6% of patients at nine retina practices.
- Staff hours spent on authorization requests can lead to higher health care costs.
The current prior authorization process required for anti-VEGF medications leads to treatment delays, increased health care costs due to administrative burdens and potentially worse visual outcomes.
A prospective study assessed nine retina practices in six U.S. states. A total of 2,365 anti-VEGF intravitreal injection prior authorization (PA) requests were logged, of which 2,225 met the inclusion criteria and 2,140 (96.2%) were approved. Sixty-four percent were reauthorizations for a previously used medication.
Image: Adobe Stock
Although the approval rate was high, only 40% of the PA requests were approved on the same day of submission, and the approval process resulted in a delay of care of 24 hours or more for 59.6% of patients. A more granular analysis showed that 23.9% of requests were approved within 1 day, 15.9% within 2 to 3 days, 21.5% within 4 to 7 days, and 26.3% within 8 to 31 days, while 12.4% required 31 days or longer.
“Numerous studies have suggested that delay of anti-VEGF pharmaceutical treatment after diagnosis is associated with worse visual outcomes,” Sabin Dang, MD, of The Retina Institute in St. Louis, and colleagues wrote.
A total of 1,742 staff hours were invested in processing PA requests, with a median of 100 minutes of staff time for each PA request.
“The results of this study support reconsideration of use of PAs for anti-VEGF medications due to administrative burdens placed on health care systems,” the authors wrote, suggesting “a more effective model to limit burgeoning health care costs.”
As a practical initial solution, they suggested eliminating PA requests for bevacizumab, which was approved 99% of the time in this study. In addition, taking into account that 64% of anti-VEGF requests were reauthorizations, this could be another target area for simplification, leading to “meaningful improvement in the current situation for many patients,” the authors wrote.
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