The Administrative Burden of Overactive Bladder Medications

Importance Preferred medications (trospium and beta-3 agonists) for overactive bladder (OAB) treatment require additional steps for insurance approval despite favorable safety profiles. Objective The objective of this study was to test the hypothesis that preferred OAB medications will have significantly higher administrative burden and delay of care compared with the administrative nonpreferred (other anticholinergic) OAB medications. Study Design This single-center mixed methods study included a retrospective chart review of adult women initiating anticholinergic or beta-3 agonist therapy for OAB between July 12, 2022 and May 21, 2024 and a prospective observational study of clinical staff from June 18, 2024 to July 19, 2024. Retrospectively, demographics, medical history, information on OAB medication approval, and the frequency of OAB medication approval tasks were collected. Prospectively, time spent by clinic staff performing OAB medication approval tasks was recorded. Results A total of 200 participants were included in the retrospective cohort and 13 participants in the prospective cohort. Most patients were prescribed a preferred (n=193) versus nonpreferred (n=7) OAB medication with no significant differences in baseline demographics. Prescription of preferred medications required a significantly higher mean number of messages compared with nonpreferred (3±7 vs. 0±0, P <0.001) and had a significantly longer time to medication approval (17±36 vs. 0±0 days; P <0.001). Mean minutes per task were 94±24 per prior authorization, 67±37 per appeal, and 2±2 per staff message. On the basis of our modeling, each prescription for a preferred OAB medication requires an additional 38 minutes of administrative time. Conclusions Preferred medications had significantly higher associated administrative burden and delay of care compared with nonpreferred OAB medications. These findings highlight the need for expanded coverage of preferred medications and streamlined approval processes.