Are prior authorizations for anti-VEGF intravitreal injections needed?

Despite an overall high approval rate for intravitreal anti-VEGF pharmaceuticals, the majority of patients experience significant delays in obtaining treatment due to the prior authorization (PA) process, according to a study presented at ASRS 2023 which underscored the administrative burden and potential negative impact on patient outcomes related to delays in PA.

Of the 33,178 PAs examined, 97.6% of requests were approved.

When analyzed individually, aflibercept had a denial rate of 2.32%, ranibizumab had a denial rate of 2.84%, and bevacizumab had the lowest denial rate at 1.94%. While the majority of requests were eventually approved, the mean time to approval was 2.75 days, with a median of 9.36 hours.

Only 2.14% of PAs received same-day authorization, leaving the vast majority of patients waiting for their treatments to be approved. This delay in care could potentially result in vision loss and hinder optimal patient outcomes, according to the presentation.

In regard to different insurance providers, Medicare Advantage had the lowest rate of PA rejections at 1.18%, followed by Medicaid at 3.87%, and commercial insurance at 3.95%. While all insurance carriers had a same-day approval rate of <4%, ranibizumab had the highest rate of same-day approval at 4.03%, followed by aflibercept at 1.96%, and finally bevacizumab at 0.76%.

Reference
Khanna S. Impact and Outcomes of Anti-VEGF Prior Authorization Requests: Insights From a Large Database Analysis. Presented at: ASRS 41st Annual Meeting.