Prior Authorization Requirements and Prescription Fill Patterns Among Patients With Heart Failure

Area of Science:

• Cardiology
• Pharmacology
• Health Services Research

Background:

• Prior authorizations can impede access to critical heart failure (HF) medications like angiotensin receptor neprilysin inhibitors (ARNIs) and sodium glucose cotransporter 2 inhibitors (SGLT2is).
• These medications are vital for reducing mortality in HF patients.

Purpose of the Study:

• To investigate the association between prior authorization requirements and the delayed or decreased filling of ARNI and SGLT2i prescriptions.
• To identify patient demographics and characteristics associated with prior authorization for these HF medications.

Main Methods:

• Retrospective cohort study utilizing electronic health records, pharmacy fill data, and neighborhood-level data.
• Inclusion of HF patients with new ARNI or SGLT2i prescriptions between April 2021 and April 2023.
• Analysis using inverse probability weighting to assess time to first fill and likelihood of never filling prescriptions.

Main Results:

• Prior authorization was required for 12.2% of ARNIs and 14.3% of SGLT2is.
• Patients needing prior authorization were more likely to be younger, non-Hispanic Black or Hispanic, and have non-Medicare insurance.
• Prior authorization was linked to significantly longer fill times for ARNIs (3.03x) and SGLT2is (6.75x), and increased likelihood of never filling SGLT2i prescriptions (2.23x).

Conclusions:

• Prior authorization requirements are more prevalent among Black and Hispanic patients.
• These requirements act as a significant barrier, leading to delayed and reduced access to guideline-recommended, mortality-reducing HF medications.
• Addressing prior authorization hurdles is crucial for equitable HF management and improving patient outcomes.