Prior authorization may reduce access to important heart failure drugs
Prior authorization requirements may be stopping some patients from filling prescriptions for heart failure medications, according to new data published in JACC: Advances.[1]
In addition, researchers noted, these requirements appear to be more common for Black and Hispanic patients, creating a critical barrier to guideline-recommended care.
The group focused on large health systems, with data from electronic health records, pharmacies and other resources. The heart of this study was prescriptions for angiotensin receptor-neprilysin inhibitors (ARNIs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is), two drug types central to the treatment of heart failure.
The final analysis included more than 2,100 patients with a new prescription for an ARNI or SGLT2i from April 2021 to April 2023. Overall, 12.2% of patients hoping to fill a prescription for an ARNI and 14.3% of patients hoping to fill a prescription for an SGLTI2i had a prior authorization requirement. These patients tended to be younger, identify as Black or Hispanic and have insurance that was not Medicare.
Heart failure patients facing a prior authorization requirement took more than three times longer to fill an ARNI prescription and nearly seven times longer to fill an SGLT2i prescription. Also, these individuals were more than two times as likely to just never fill their SGLT2i prescription. They did face an increased risk of never filing an ARNI prescription, but that difference was not statistically significant.
“Our results indicate that prior authorization requirements may be contributing to the substantial health disparities seen in heart failure care and need to be carefully reexamined,” senior author Saul B. Blecker, MD, an associate professor in the NYU Grossman School of Medicine’s departments of population health and medicine, said in a statement.
Lead author Amrita Mukhopadhyay, MD, a cardiologist with NYU Grossman School of Medicine’s department of medicine, added that prior authorization policies “may be doing harm” to these patients by keeping important medications out of their reach.
“While these policies are meant to control healthcare costs by steering patients toward lower-priced alternatives, they may instead be keeping people with heart failure from timely access to lifesaving treatments,” she said.
These researchers appear to just be getting started. They are already working on a similar study focused on “copays, coinsurance, and other elements of insurance.”
Click here to read the full analysis in JACC: Advances, an American College of Cardiology journal.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.