Prior Authorization Changes Can Reduce Access to Oral Anticancer Drugs

Changes to prior authorization policies can increase the likelihood that patients will delay or stop filling prescriptions for oral anticancer drugs, according to research published in the Journal of Clinical Oncology.

Researchers used Medicare part D claims data from 2010 to 2020 to assess the effects of prior authorization changes on filling prescriptions for 11 oral anticancer drugs.

The study included 2495 beneficiaries who were filling prescriptions for these drugs with a new prior authorization policy and 22,641 beneficiaries who were filling prescriptions for the same drugs with no change in prior authorization policy.

“Because prior authorization is so prevalent among oral anticancer drugs, more than 90% of the group without a policy change were subject to prior authorization throughout the study period,” the researchers noted. “This means the results reflect the difference between new and preexisting prior authorizations rather than no prior authorization at all.”

The researchers examined prescription fills and refills within 120 days of January 1 of each year in the study period. January 1 was chosen as the index date because new preauthorization requirements and changes in out-of-pocket costs are typically introduced at the start of a new year, the researchers explained.

They found that patients who were exposed to a new prior authorization policy had 7-fold higher odds of discontinuing their drug regimen than patients who had no changes in prior authorization (adjusted odds ratio, 7.1; 95% CI, 6.0-8.5; P <.001).

The adjusted probability of discontinuing a drug within 120 days after the index date was 5.8% for patients who had a new prior authorization policy and 1.4% for those who did not.

Prior to the index date, the expected time to next fill a 30-day supply of medication was 32.3 days for patients with a new prior authorization policy and 32.2 days for patients without any changes to prior authorization.

For the first fill after the index date, the adjusted to time fill a 30-day supply of medication was 48.6 days for patients with a new prior authorization policy and 38.7 days for patients without any changes. 

“This important analysis associates oral anticancer drug discontinuation and delayed prescription fills among Medicare enrollees with prior authorization requirements,” Stephanie B. Wheeler, PhD, associate editor of the journal, wrote in a comment. “Such prior authorization requirements by insurers may introduce unnecessary administrative burdens that reduce timely access to appropriate treatment and should be carefully addressed through policy change considerations.”

Reference

Kyle MA, Keating NL. Prior authorization and association with delayed or discontinued prescription fills. J Clin Oncol. Published online December 12, 2023. doi:10.1200/JCO.23.01693

This article originally appeared on Cancer Therapy Advisor