The Burden of Prior Authorizations in Bleeding Disorder Specialty Drugs

Prior authorizations (PAs) are widely used to control healthcare costs and ensure appropriate use of high-cost therapies, but they often create undue administrative burdens. In haemophilia care, timely access to specialty medications is critical, yet Haemophilia Treatment Centres (HTCs) must frequently navigate payer-driven PA requirements that can delay treatment and disrupt care delivery. To our knowledge, this study is the first of its kind to examine how the PA process affects patient care and provider workloads in HTCs METHODS: Twenty staff from federally designated HTCs across the United States were purposively recruited to participate in virtual, semi-structured interviews. Eligible participants were directly involved in the PA process. Interviews were recorded, transcribed, and de-identified. Data were analyzed using conventional content analysis with independent coding by two investigators, supported by Dedoose software. Descriptive statistics summarized participant characteristics, and the labour-time and cost estimate was estimated by annualizing labour costs using mean weekly hours spent on PAs and position-specific wage rates.

A thematic analysis revealed four themes related to PA challenges and the burden on care delivery. The mean weekly time spent on PAs was 6.5 h per participant. Eighty-five percent of participants reported burnout related to PAs. The labour-time and cost estimate per participant-year spent on PAs ranged from $4795 (nurse practitioner) to $20,718 (non-clinical staff).

The findings emphasize the need for efficient, clinically informed PA processes to reduce administrative burden and care delays, and identify a need for further education for insurers, potentially at the national level.