Prior authorization for FDA-approved PARP inhibitors in ovarian cancer
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 examin...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-04-01
|
| Series: | Gynecologic Oncology Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352578924000146 |
| _version_ | 1797234322654101504 |
|---|---|
| author | Anna Jo Bodurtha Smith Annie Apple Audra Hugo Ashley Haggerty Emily M. Ko |
| author_facet | Anna Jo Bodurtha Smith Annie Apple Audra Hugo Ashley Haggerty Emily M. Ko |
| author_sort | Anna Jo Bodurtha Smith |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-08T00:22:40Z |
| format | Article |
| id | doaj.art-3167e979ba3245dbb1fdc03276bf5080 |
| institution | Directory Open Access Journal |
| issn | 2352-5789 |
| language | English |
| last_indexed | 2024-04-24T16:30:14Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Gynecologic Oncology Reports |
| spelling | doaj.art-3167e979ba3245dbb1fdc03276bf50802024-03-30T04:39:21ZengElsevierGynecologic Oncology Reports2352-57892024-04-0152101335Prior authorization for FDA-approved PARP inhibitors in ovarian cancerAnna Jo Bodurtha Smith0Annie Apple1Audra Hugo2Ashley Haggerty3Emily M. Ko4Division 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; Corresponding author.Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United StatesDepartment of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, PA, United StatesDivision 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 StatesDivision 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 StatesObjectives: 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.http://www.sciencedirect.com/science/article/pii/S2352578924000146InsuranceMedicareMedicaidOvarian cancerPARP inhibitorsPrior Authorization |
| spellingShingle | Anna Jo Bodurtha Smith Annie Apple Audra Hugo Ashley Haggerty Emily M. Ko Prior authorization for FDA-approved PARP inhibitors in ovarian cancer Gynecologic Oncology Reports Insurance Medicare Medicaid Ovarian cancer PARP inhibitors Prior Authorization |
| title | Prior authorization for FDA-approved PARP inhibitors in ovarian cancer |
| title_full | Prior authorization for FDA-approved PARP inhibitors in ovarian cancer |
| title_fullStr | Prior authorization for FDA-approved PARP inhibitors in ovarian cancer |
| title_full_unstemmed | Prior authorization for FDA-approved PARP inhibitors in ovarian cancer |
| title_short | Prior authorization for FDA-approved PARP inhibitors in ovarian cancer |
| title_sort | prior authorization for fda approved parp inhibitors in ovarian cancer |
| topic | Insurance Medicare Medicaid Ovarian cancer PARP inhibitors Prior Authorization |
| url | http://www.sciencedirect.com/science/article/pii/S2352578924000146 |
| work_keys_str_mv | AT annajobodurthasmith priorauthorizationforfdaapprovedparpinhibitorsinovariancancer AT annieapple priorauthorizationforfdaapprovedparpinhibitorsinovariancancer AT audrahugo priorauthorizationforfdaapprovedparpinhibitorsinovariancancer AT ashleyhaggerty priorauthorizationforfdaapprovedparpinhibitorsinovariancancer AT emilymko priorauthorizationforfdaapprovedparpinhibitorsinovariancancer |