American journal of ophthalmology · 2025
Physician Burden and Time Delays in Initiating Immunomodulatory Therapy for Noninfectious Uveitis and Inflammatory Eye Diseases.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Duran Munevver N, Beltran Karen, Cao Jennifer H
Аннотация
PURPOSE: To assess the additional time and effort required and resultant delays imposed by insurance-mandated prior authorization for medications treating uveitis and ocular inflammatory disease.
DESIGN: Retrospective cohort study.
PARTICIPANTS: Patients with uveitis and ocular inflammatory disease at the University of Texas Southwestern Medical Center requiring approval for new systemic immunomodulatory therapy between February 2023 and January 2024. Infusion-related medications were excluded.
METHODS: Electronic medical records were reviewed to assess prior authorization requests, appeals, and related data for initiating therapy.
MAIN OUTCOME MEASURES: Success rate of obtaining requested medications, time to initiation, additional steps required (eg, appeals, peer-to-peer consultations), factors influencing approval (eg, insurance subtype, medication class), and reliance on patient assistance programs.
RESULTS: A total of 83 patients had 107 requests for new immunomodulatory therapy. Uveitis subtypes included pemphigoid (38%), anterior uveitis (13%), intermediate uveitis (8%), posterior uveitis (1%), panuveitis (35%), and scleritis (5%). Medications included methotrexate (20.6%), mycophenolate mofetil (12.1%), adalimumab (34.6%), tocilizumab (1.9%), baricitinib (16.8%), and tofacitinib (9.3%), with 75% considered "off-label." Approval rates were 100% for on-label and 52.3% for off-label medications (P = .033). Off-label requests were twice as likely to be denied, requiring more appeals (1.07 vs 0.50; P = .01). Average time to initiation was 28 days for on-label and 41 days for off-label medications (P = .01). Private insurance had higher approval rates than Medicare for off-label requests (59.5% vs 36.4%; P = .05). Patient assistance programs were required in 63% of cases.
CONCLUSION: Prior authorization creates significant administrative burdens and delays, disproportionately affecting off-label therapies and delaying critical vision-preserving treatments.
DESIGN: Retrospective cohort study.
PARTICIPANTS: Patients with uveitis and ocular inflammatory disease at the University of Texas Southwestern Medical Center requiring approval for new systemic immunomodulatory therapy between February 2023 and January 2024. Infusion-related medications were excluded.
METHODS: Electronic medical records were reviewed to assess prior authorization requests, appeals, and related data for initiating therapy.
MAIN OUTCOME MEASURES: Success rate of obtaining requested medications, time to initiation, additional steps required (eg, appeals, peer-to-peer consultations), factors influencing approval (eg, insurance subtype, medication class), and reliance on patient assistance programs.
RESULTS: A total of 83 patients had 107 requests for new immunomodulatory therapy. Uveitis subtypes included pemphigoid (38%), anterior uveitis (13%), intermediate uveitis (8%), posterior uveitis (1%), panuveitis (35%), and scleritis (5%). Medications included methotrexate (20.6%), mycophenolate mofetil (12.1%), adalimumab (34.6%), tocilizumab (1.9%), baricitinib (16.8%), and tofacitinib (9.3%), with 75% considered "off-label." Approval rates were 100% for on-label and 52.3% for off-label medications (P = .033). Off-label requests were twice as likely to be denied, requiring more appeals (1.07 vs 0.50; P = .01). Average time to initiation was 28 days for on-label and 41 days for off-label medications (P = .01). Private insurance had higher approval rates than Medicare for off-label requests (59.5% vs 36.4%; P = .05). Patient assistance programs were required in 63% of cases.
CONCLUSION: Prior authorization creates significant administrative burdens and delays, disproportionately affecting off-label therapies and delaying critical vision-preserving treatments.