Prior Authorization and Association With Delayed or Discontinued Prescription Fills

Area of Science:

• Health Services Research
• Oncology Pharmacy
• Health Policy Analysis

Background:

• Prior authorization (PA) requirements are increasingly common for prescription drugs.
• The impact of PA policies on patient access to oral anticancer medications is not well understood.

Purpose of the Study:

• To examine the association between new prior authorization policies and delayed or discontinued prescription fills for oral anticancer drugs.
• To assess the impact of PA on medication access for Medicare Part D beneficiaries.

Main Methods:

• Utilized Medicare Part D claims data from 2010-2020.
• Compared beneficiaries filling specific oral anticancer drugs before and after a PA policy change in their plan.
• Employed difference-in-differences and regression analyses to evaluate drug discontinuation and time to next fill.

Main Results:

• Introduction of PA policies increased the odds of drug discontinuation within 120 days by 7.1 times (aOR, 7.1; P < .001).
• PA policies increased the time to the next prescription fill by an average of 9.7 days (P < .001).

Conclusions:

• New prior authorization policies for oral anticancer drugs are linked to higher rates of discontinued and delayed patient care.
• These PA policies may represent significant clinical barriers to accessing necessary cancer treatments.
• Consideration should be given to waiving PA for patients already established on a drug regimen to improve adherence.