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Sofia MA, Feuerstein JD, Narramore L, Chachu KA, Streett S. White Paper: American Gastroenterological Association Position Statement: The Future of IBD Care in the United States-Removing Barriers and Embracing Opportunities. Clin Gastroenterol Hepatol 2024; 22:944-955. [PMID: 38428707 DOI: 10.1016/j.cgh.2024.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/14/2023] [Accepted: 01/15/2024] [Indexed: 03/03/2024]
Abstract
Despite incredible growth in systems of care and rapidly expanding therapeutic options for people with inflammatory bowel disease, there are significant barriers that prevent patients from benefiting from these advances. These barriers include restrictions in the form of prior authorization, step therapy, and prescription drug coverage. Furthermore, inadequate use of multidisciplinary care and inflammatory bowel disease specialists limits patient access to high-quality care, particularly for medically vulnerable populations. However, there are opportunities to improve access to high-quality, patient-centered care. This position statement outlines the policy and advocacy goals that the American Gastroenterological Association will prioritize for collaborative efforts with patients, providers, and payors.
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Affiliation(s)
- M Anthony Sofia
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland Oregon.
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Leslie Narramore
- American Gastroenterological Association, Government Affairs Department, Bethesda, Maryland
| | - Karen A Chachu
- Division of Gastroenterology, Department of Medicine, Duke University, Durham, North Carolina
| | - Sarah Streett
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, California
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Smith AJB, Apple A, Hugo A, Haggerty A, Ko EM. Prior authorization for FDA-approved PARP inhibitors in ovarian cancer. Gynecol Oncol Rep 2024; 52:101335. [PMID: 38390624 PMCID: PMC10878851 DOI: 10.1016/j.gore.2024.101335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
Objectives PARP inhibitors (PARP-I) improve survival in ovarian cancer, especially in patients with germline or somatic BRCA mutations or other homologous recombination deficiency (HRD). With high efficacy and costs, insurers may enact barriers or facilitators to PARP-I. Our objective was to examine the prevalence of prior authorization for PARP-I in ovarian cancer. Methods We performed a retrospective cross-sectional study of patients with ovarian cancer prescribed a PARP-I within the University of Pennsylvania practices from December 2018 through May 2021. We assessed prevalence of prior authorization for PARP-I overall, by frontline or recurrent maintenance, and by genetic status. We then assessed approval and appeal rates and time to PARP-I start. Results Of 180 patients with a PARP-I prescription and information regarding prior authorization, 116 (64 %, 95 % CI 57-71) experienced prior authorization. Of patients in the frontline setting, 60 of 90 (67 %, 95 % CI 56-76) experienced prior authorization. Of patients prescribed PARP-I in recurrence, 55 of 85 (65 %, 95 % CI 54-74) experienced prior authorization. Having a germline or somatic genetic mutation was associated with higher risk of prior authorization (adjusted risk ratio 1.35, 95 %CI 1.09-1.67). 102 patients (89 %, 95 % CI 83-94) required one appeal, 8 required two appeals and 5 cases required 3 appeals. Five patients were denied. Mean time from PARP-I prescription to PARP-I start was 10 days longer for patients who experienced prior authorization. Conclusions 64% of patients experienced prior authorization for PARP-I. Risk of prior authorization was increased for patients with BRCA, despite greater clinical benefit. Prior authorization contributes to delays in care, and reform is needed.
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Affiliation(s)
- Anna Jo Bodurtha Smith
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States
- Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States
- University of Pennsylvania, Leonard Davis Institute of Health Economics, University of Pennsylvania Health Systems, Philadelphia, PA, United States
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania Health Systems, Philadelphia, PA, United States
| | - Annie Apple
- Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States
| | - Audra Hugo
- Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States
| | - Ashley Haggerty
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States
- Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States
- Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, NJ, United States
| | - Emily M. Ko
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States
- Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United States
- University of Pennsylvania, Leonard Davis Institute of Health Economics, University of Pennsylvania Health Systems, Philadelphia, PA, United States
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania Health Systems, Philadelphia, PA, United States
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Robinson JC. Pharmacy Benefit Management: The Cost of Drug Price Rebates. J Law Med Ethics 2024; 51:52-54. [PMID: 38433678 DOI: 10.1017/jme.2023.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Pharmacy Benefit Managers (PBM) induce drug manufacturers to offer rebates to insurers and employers by denying coverage through formulary exclusions, impeding physician prescription through prior authorization, and reducing patient drug use through cost sharing. As they tighten these access obstacles, PBMs reduce the net prices received by the manufacturers.
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Sundaram P, Bhatt V, Feustel P, Mian B. Burden of Prior Authorization Requirements on Urology Practice and Patients. Urology 2022; 169:76-83. [PMID: 35961563 DOI: 10.1016/j.urology.2022.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 05/22/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the final outcomes of various types of prior authorizations (PAs), and to quantify the administrative and financial burden of PAs on urology practice. PAs are often required before imaging, procedures or medications can be ordered. However, they can delay timely delivery of patient care and place a significant administrative burden on practices. The impact of PAs has been poorly studied, and no studies on PAs' burden on urology practice are available. METHODS Imaging and medications requiring PAs from an outpatient urology clinic from November 2020 to February 2021 were reviewed (n=267). Authorization outcomes were tracked to resolution. We calculated the time spent on PAs, and the estimated overall financial burden on the practice. RESULTS Of the PAs required, 60.6% were for imaging and 39.4% were for medications. Initial decision for PAs took a median of 2 days [IQR: 0-6, Range: 0-36], whereas decisions after an appeal (n=51) took a median of 10 days [IQR: 5-23, range 0-125 days]. Private insurance compared to Medicare or Medicaid, has an earlier time to decision (p=<0.001). Initial approval rates were 67.5%, and final approval rates after appeals were 88.2%. Of orders originally denied, a majority (77.3%) were appealed, 13.6% required alternative orders, and 7.6% paid out of pocket. The total cost to the practice was $2206.06, with a $15.11 mean cost of each PA. CONCLUSIONS PAs for imaging studies and medications pose a significant administrative and financial burden to urology patients and practice.
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Affiliation(s)
- Padmaja Sundaram
- Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, 518-262-5879.
| | - Vikas Bhatt
- Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, 518-262-5879.
| | - Paul Feustel
- Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, 518-262-5879.
| | - Badar Mian
- Albany Medical College, 47 New Scotland Ave, Albany, NY 12208, 518-262-5879.
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