ArticleArthritis care & research2020
Treatment Delays Associated With Prior Authorization for Infusible Medications: A Cohort Study.
Article in Arthritis care & research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 41 citations in OpenAlex.
- The association between cost sharing, prior authorization, and specialty drug utilization: A systematic review.Journal of managed care & specialty pharmacy · 2023Pooled it
- U.S. health plan coverage of Neuromuscular Disease Therapies: An assessment of policy availability and restrictions.Journal of neuromuscular diseases · 2026Article
- A Qualitative Exploration of Adherence to Methotrexate in Juvenile Idiopathic Arthritis.The Journal of pediatrics · 2026Article
- Differences in time to drug initiation and inactive disease achievement by insurance type in patients with nonsystemic juvenile idiopathic arthritis.Drugs & therapy perspectives : for rational drug selection and use · 2026Article
- Real-world phosphorodiamidate morpholino oligomer treatment patterns in Duchenne muscular dystrophy: a claims-based analysis.Journal of comparative effectiveness research · 2025Article
- State-level variation in access to long-acting injectable antiretroviral therapy for HIV in the United States.Health affairs scholar · 2025Article
- Assessment of Phosphorodiamidate Morpholino Oligomer Treatment Patterns for Patients with Duchenne Muscular Dystrophy: A MarketScan Claims Analysis.Advances in therapy · 2025Article
- Beyond Being Insured: Insurance Coverage Denial as a Major Barrier to Accessing Care During Pregnancy and Postpartum.Clinical nursing research · 2023Article
- Insurance Status and Tumor Necrosis Factor Inhibitor Initiation Among Children With Juvenile Idiopathic Arthritis in the CARRA Registry.The Journal of rheumatology · 2023Article
- Influence of prior authorization requirements on provider clinical decision-making.The American journal of managed care · 2023Article
- Navigating Access and Optimizing Medication Infusions in an Academic Medical Center: A Quality Improvement Study.Pharmacy (Basel, Switzerland) · 2023Article
- Association between low-income subsidies and inequities in orally administered antimyeloma therapy use.The American journal of managed care · 2023Article
- Barriers to optimizing inflammatory bowel disease care in the United States.Therapeutic advances in gastroenterology · 2023Review
- Insurance Delays in Initiation of Tumor Necrosis Factor Inhibitors in Children With Juvenile Idiopathic Arthritis.JAMA network open · 2022Article
- Delays Related to Prior Authorization in Inflammatory Bowel Disease.Pediatrics · 2022Article
- A comprehensive framework for navigating patient care in systemic sclerosis: A global response to the need for improving the practice of diagnostic and preventive strategies in SSc.Best practice & research. Clinical rheumatology · 2021Review
- Increasing Operational Capacity and Reducing Costs of Rituximab Administration: A Costing Analysis.ACR open rheumatology · 2020Article
- The Impact of Insurance Restrictions in Newly Diagnosed Individuals With Multiple Sclerosis.International journal of MS careArticle
- Medicare Coverage for Diabetes Management: A Primary Care Professional's Guide to Advocacy and Navigation.Diabetes, obesity, and cardiometabolic CAREArticle
- Automated versus manual prior authorization for diabetes mellitus drugs: A retrospective study from Israel.Digital healthArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
objectivePrior authorizations (PAs) are commonly used by health payers as cost-containment strategies for expensive medications, including infused biologics. There is scarce data about the effect of PA requirements on patient-oriented outcomes.
methodsWe included patients for whom an infusible medication was prescribed for a rheumatologic condition. The exposures of interest were a PA requirement and whether or not the PA was denied. The primary outcome was the difference in days from medication request to infusion. Secondary outcomes included the proportion of denied PAs and differences in glucocorticoid exposure following a PA request.
resultsOf the 225 patients, the infusible medications of 160 (71%) required a PA. PAs were associated with a greater number of days to infusion compared to cases in which no authorization was required (median 31 days [interquartile range (IQR) 15-60 days] versus median 27 days [IQR 13-41 days]; P = 0.045), especially among the 33 patients (21%) whose PA was denied initially (median 50 days [IQR 31-76 days] versus median 27 days [IQR 13-41 days]; P < 0.001). PA denials were associated with greater prednisone-equivalent glucocorticoid exposure in the 3 months following the request than when a PA was not required (median 605 mg [IQR 0-1,575] versus median 160 mg [IQR 0-675]; P = 0.01). Twenty-seven of the 33 PA requests that were initially denied (82%) were eventually approved. Thus, 96% of all PAs were ultimately approved.
conclusionPA requirements are associated with treatment delays and denials are associated with greater glucocorticoid exposure. Because the great majority of PA requests are ultimately approved, the value of PA requirements and their impact on patient safety should be reevaluated.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.