■抗血管内皮生长因子(VEGF)玻璃体内注射,治疗许多视网膜疾病以优化视觉结果的主要方法,已包含在事先授权(PA)计划中。然而,如果临床医生使用抗VEGF药物非常准确,这种行政负担可能需要重新考虑。
■量化抗VEGF药物的PA(阿柏西普,雷珠单抗,和贝伐单抗)获得批准,并确定视网膜实践所经历的相关行政负担。
■从2022年1月至2022年6月进行的前瞻性多中心质量改进研究,参与者是美国的9家私人视网膜诊所。
■PA请求的总体批准率,请求PA的原因,以及PA程序导致的总体护理延迟率。
■总共,记录了2365个PA请求,其中2225项符合纳入标准。总的来说,2140份(96.2%)申请获得批准。请求PA的最常见原因,64%(2225个请求中的1423个),是对以前使用过的药物的重新授权。在2140份批准中,59.6%(1277)导致护理延迟超过24小时,40%(863人)是在服务日期给予的。在对延迟批准的子集进行细粒度分析时,23.9%(725个中的173个)在1天内获得批准,15.9%(725个中的115个)在2至3天内获得批准,21.5%(725个中的156个)在4至7天内获得批准,26.3%(725个中的191个)在8至31天内获得批准,12.4%(725个中的90个)在31天以上获得批准。总的来说,PA拒绝阶梯治疗的请求为2.9%(2225中的65),未发现的诊断为0.9%(2225中的20)。获得单个PA的员工时间中位数为100(范围,0-200)分钟。
■在这项研究中,PA请求几乎总是被批准,但导致大多数患者的患者护理延迟。目前的研究表明,如果这些结果可以推广到美国的其他实践,并且如果负担较少,成本较低的方法可以导致类似的批准率,那么PA过程可能对视网膜专家无效。潜在的短期解决方案可能包括消除贝伐单抗的PA过程和对已建立的患者的重新授权。
UNASSIGNED: Anti-vascular endothelial growth factor (VEGF) intravitreal injections, a mainstay of treatment for many retinal diseases to optimize visual outcomes, have been included in prior authorization (PA) initiatives. However, if clinicians are extremely accurate in their use of anti-VEGF medications, such administrative burdens may need reconsideration.
UNASSIGNED: To quantify PA for anti-VEGF medications (aflibercept, ranibizumab, and bevacizumab) that were approved and determine associated administrative burdens experienced by retina practices.
UNASSIGNED: Prospective multicenter quality improvement study conducted from January 2022 through June 2022, and participants were 9 private retina practices across the US.
UNASSIGNED: Overall rate of approval of PA requests, reasons for requesting PA, and overall rate of delay of care resulting from PA procedures.
UNASSIGNED: In total, 2365 PA requests were recorded, 2225 of which met inclusion criteria. Overall, 2140 (96.2%) requests were approved. The most common reason for requesting PA, at 64% (1423 of 2225 requests), was reauthorization for a previously utilized medication. Of the 2140 approvals, 59.6% (1277) resulted in a delay in care greater than 24 hours, and 40% (863) were given on the date of service. In a granular analysis of a subset of delayed approvals, 23.9% (173 of 725) were approved within 1 day, 15.9% (115 of 725) were approved within 2 to 3 days, 21.5% (156 of 725) were approved within 4 to 7 days, 26.3% (191 of 725) were approved within 8 to 31 days, and 12.4% (90 of 725) were approved within more than 31 days. Overall, PA denial for step therapy was 2.9% (65 of 2225) of requests and uncovered diagnoses was 0.9% (20 of 2225) of requests. The median staff time spent to obtain a single PA was 100 (range, 0-200) minutes.
UNASSIGNED: In this study, PA requests were almost always approved but led to a delay in patient care in most patients. The current study suggests that the PA process may not be effective for retina specialists if these results can be generalized to other practices in the US and if less burdensome and less costly approaches could result in similar approval rates. Potential short-term solutions may include eliminating the PA process for bevacizumab and reauthorizations for established patients.