Prior authorization requirements for ARNI and SGLT2i were associated with significantly delayed filling and a 2.23-fold higher likelihood of never filling SGLT2i prescriptions (P<0.001).
Cohort (n=2,183)
Does prior authorization requirement delay or decrease filling of ARNI and SGLT2i in patients with heart failure?
Prior authorization requirements are associated with significant delays and decreased likelihood of filling guideline-recommended ARNI and SGLT2i prescriptions in heart failure patients, disproportionately affecting Black and Hispanic patients.
Effect estimate: RR 2.23 (95% CI 1.37-3.65)
p-value: p=<0.001
BACKGROUND: Prior authorizations could hinder the filling of life-saving heart failure (HF) medications, such as angiotensin receptor neprilysin inhibitors (ARNIs) and sodium glucose cotransporter 2 inhibitors (SGLT2is). OBJECTIVES: The aim of the study was to determine whether prior authorizations were associated with delayed or decreased filling for ARNI and SGLT2i. METHODS: This was a retrospective cohort study using electronic health record, pharmacy fill, and neighborhood-level data from a large, academic health system. We included patients with HF and a new prescription for ARNI or SGLT2i between April 1, 2021, and April 30, 2023, and assessed for presence of prior authorization requirement. Outcomes included days to first fill and never filling the prescription. Analyses were conducted using inverse probability weighting methods. RESULTS: Among 2,183 patients, 12.2% (152/1,243) and 14.3% (165/1,150) had a prior authorization requirement for ARNI or SGLT2i, respectively. Patients requiring prior authorization tended to be younger, identify as non-Hispanic Black or Hispanic, have non-Medicare insurance, and have fewer comorbidities. In weighted models, patients requiring prior authorization took 3.03 (95% CI: 2.16-4.25) times longer to fill ARNI, 6.75 (95% CI: 4.44-10.3) times longer to fill SGLT2i, and were 2.23 (95% CI: 1.37-3.65) times more likely to never fill SGLT2i prescriptions (all P < 0.001). CONCLUSIONS: Prior authorization requirements were more common for patients identifying as Black or Hispanic and were associated with decreased and delayed filling of ARNI and SGLT2i. Our findings highlight an important barrier to mortality-reducing, guideline-recommended medications for HF.
Mukhopadhyay et al. (Sat,) conducted a cohort in Heart Failure (n=2,183). Prior authorization requirement vs. No prior authorization requirement was evaluated on Days to first fill and never filling the prescription (RR 2.23, 95% CI 1.37-3.65, p=<0.001). Prior authorization requirements for ARNI and SGLT2i were associated with significantly delayed filling and a 2.23-fold higher likelihood of never filling SGLT2i prescriptions (P<0.001).