The Saturday, September 10th, in the Biologics sessions of this year’s American Rhinology Society conference, researchers from Thomas Jefferson University presented a paper titled “Dupilumab Initiation Delays Related to Prior Authorization (PA) in Moderate to Severe Asthma and Chronic Rhinosinusitis with Nasal Polyps.”
Dupilumab has greatly improved the outcomes in patients with asthma and nasal polyps, but biologic use is limited due to its high cost. The insurance companies still use Prior Authorization (PA) requirements. The results suggest that delay in Dupilumab treatment initiation was significantly associated with an increased rate of oral antibiotics and acute healthcare utilization.
The aim of this single-center retrospective cohort study was to
- Assess the impact of prior authorization requirements on Dupilumab initiation time and disease exacerbation in patients with asthma and Chronic Rhinosinusitis with Nasal Polyps (CRSwNP).
Prior studies have reported that PA requirements may cause a delay in biologic initiation in other allergic and inflammatory diseases such as Inflammatory Bowel Disease, placing patients at risk of disease exacerbation. The authors claim that this is the first study to assess the impact of prior authorization requirements on Dupilumab initiation time and disease exacerbation in patients with asthma and CRSwNP.
The times for insurance approval through prioritization and first biologic injection were reviewed, along with assessing patient demographics for clinical outcomes and built utilization during the initiation window.
- Out of 95 patients identified, six did not require prioritization and the remaining 89 required prioritization
- The median time to fulfill that initiation and those who didn’t require a prioritization was 22 days
- No significant difference in demographics, insurance type indication, or baseline clinical variables was found between the two groups who required PA approval and those who did not need PA
- Seventy-three patients had prioritization approved, and 16 had an initial denial.
- The time to initial approval was one day, and for the denied group was nine days.
- Those who had PA denial utilized antibiotics at a greater frequency than others, and half of them required oral steroids during this period
- It was found that patients with paid denial had a very frequency of acute healthcare utilization, which is either urgent care, emergency visits, etc.
- The delayed access to oral steroid medication and increased systemic steroid use exposes the risk of adverse effects on patients with comorbidities.
Future Policy Implications
- The time between prescription and biological initiation should be expedited.
- Reform is needed in the prior authorization policies to ensure that patients with chronic diseases have safe, appropriate, and timely access to biologics to reduce their disease burden and patient education regarding initiating biologic therapies.
The authors of the study were Samiat Awosanya, MS, K.Arielle Best, MS, Kathleen Gillmore, BA, Emily Garvey, BS, Douglas Farquhar, MD, Chandala Chitguppi, MD, Mindy Robinowitz, MD, Marc Rosen, MD, Elina Toskala, MD, PhD, MBA, Gurston Nyquist, MD1 from the Department of Otolaryngology- Head and Neck Surgery, Thomas Jefferson University, and Jessica Most, MD from the Department of Pulmonology, Thomas Jefferson University.