Delays Related to Prior Authorization in Inflammatory Bowel Disease

Delays in advancing to biologic therapies may lead to adverse outcomes in inflammatory bowel disease (IBD). Insurer-mandated prior authorizations may cause prolonged medication initiation times.

Constant BD. et al., in their recent study, hypothesized that prior authorizations are associated with long biologic initiation time and raised IBD-related healthcare utilization among children with IBD.

They performed a retrospective cohort study of 190 pediatric patients with IBD initiating biologics to measure the association between:

• prior authorization, 
• biologic initiation time (physician recommendation to first dose),
• healthcare utilization like hospitalization, surgery, or emergency department visit.

They collected the demographic, insurance, and disease severity–related covariables; and performed Multivariable linear regression to measure the association between prior authorization and biologic initiation time. 

They measured the associations between prior authorization and IBD-related healthcare utilization within 180 days and corticosteroid dependence at 90 days, with adjustment for insurance type, demographics, and disease severity–related characteristics, using Propensity score methods.

The investigators found the Median biologic initiation time to be 21 days. Prior authorization and complicated prior authorizations (requiring appeal, step therapy, or peer-to-peer review) caused 10.2-day and 24.6-day increases in biologic initiation time, respectively. Prior authorizations improved the likelihood of IBD-related healthcare utilization within 180 days by 12.9% and corticosteroid dependence at 90 days by 14.1%.

Thus, Prior authorizations are associated with prolonged biologic initiation time and increased IBD-related healthcare utilization. Hence, Minimizing prior authorization–related delays may accelerate biologic delivery and reduce the risk of IBD-related healthcare utilization.

Constant BD, de Zoeten EF, Stahl MG, et al. Delays Related to Prior Authorization in Inflammatory Bowel Disease. Pediatrics. 2022;149 (3): e2021052501. https://doi.org/10.1542/peds.2021-052501