The American College of Rheumatology (ACR) has issued a list of recommendations for streamlining prior authorization to eliminate redundancy and improve access for patients.
Prior authorization (PA) for rheumatology drugs, many of which are biologics or biosimilars, needs to be improved as it can cause delays in care and is burdensome for providers and patients, the American College of Rheumatology (ACR) said in an official position statement.
“For patients with complex conditions like rheumatic disease, these delays may last weeks or even months and can be the difference between successful treatment or permanent joint damage and disability,” said Virginia Reddy, MD, lead author of the statement and a member of the ACR’s Committee on Rheumatologic Care.
"In addition to creating additional hoops for patients and providers to jump through, prior authorization diverts valuable time away from caring for patients and toward repetitive and time-consuming administrative tasks,” she added.
Although payers require PA for the purposes of oversight and control over providers’ prescribing practices, the ACR said this process is often time-consuming and diverts resources away from direct patient care.
The ACR’s patient registry data found that approximately 15% of patients in a typical rheumatology practice have rheumatoid arthritis and are treated with a medication that requires PA. For each of these patients, clinicians must go through the PA process at least once per year due to annual therapy renewal requirements for insurance plans.
The ACR said PA requirements are not standardized across payers, and providers frequently must fill out multi-page forms manually for each patient, which affects timely treatment of patients.
The ACR’s 5 main recommendations to modernize and simplify the PA process:
"It is crucial that these improvements be made with careful, deliberate attention to each targeted area so that patients can receive the treatment they need without unnecessary delays," Reddy said.
In a national survey conducted by the American Medical Association, 75% of physicians reported that PA can lead to patients abandoning therapies. Additionally, 91% of physicians indicated they believe that the PA process delayed patients’ access to care, and 88% of physicians reported that the burden associated with PA has increased in the last 5 years.
Current legislation aimed at minimizing PA issues for patients includes the Improving Seniors’ Timely Access to Care Act, or HR 3107. The bipartisan bill would require CMS to regulate PA use by Medicare Advantage plans and establish a process to make “real-time decisions” for services that are routinely approved.
It also would require plans to offer a process for electronic PA and to report to CMS how much they use, approve, and deny PA.
The ACR is an international society with a membership of over 8500 rheumatologists and rheumatology professionals.
Breaking Barriers in Osteoporosis Care: New Denosumab Biosimilars Wyost, Jubbonti Approved
June 16th 2024In this episode, The Center for Biosimilars® delves into the FDA approval of the first denosumab biosimilars, Wyost and Jubbonti (denosumab-bbdz), and discuss their potential to revolutionize osteoporosis treatment with expert insights from 2 rheumatologists.
Eye on Pharma: EC Approved Ustekinumab; Zymfentra Expansion; Biosimilar Policy Briefing
September 26th 2024The European Commission (EC) approved Celltrion's ustekinumab biosimilar for chronic inflammatory diseases, Celltrion expanded access to Zymfentra (subcutaneous infliximab-dyyb) through partnerships with Cigna and Express Scripts, and the Association for Accessible Medicines held a policy briefing addressing barriers to biosimilar adoption.
Insights from Festival of Biologics: Dracey Poore Discusses Cardinal Health’s 2024 Biosimilar Report
May 19th 2024The discussion highlights key emerging trends from the Festival of Biologics conference and the annual Cardinal Health Biosimilars Report, including the importance of sustainability in the health care landscape and the challenges and successes in biosimilar adoption and affordability.
Real-World Study Shows Comparable Outcomes Between CT-P13, Remicade in RA
September 14th 2024A real-world study of the biosimilar infliximab-dyyb (CT-P13; Inflectra) in rheumatoid arthritis (RA) reported the majority of patients who initiated CT-P13 switched from the reference product (Remicade) or another biologic or targeted synthetic disease-modifying antirheumatic drug.
Comparable Disease Activity, Drug Persistence in Patients With JIA Who Switch to Biosimilars
September 12th 2024Switching children with juvenile idiopathic arthritis (JIA) from anti–tumor necrosis factor originators to biosimilars showed similar disease activity and drug persistence, with good tolerability, supporting the safety and effectiveness of non-medical switching.
Breaking Barriers in Osteoporosis Care: New Denosumab Biosimilars Wyost, Jubbonti Approved
June 16th 2024In this episode, The Center for Biosimilars® delves into the FDA approval of the first denosumab biosimilars, Wyost and Jubbonti (denosumab-bbdz), and discuss their potential to revolutionize osteoporosis treatment with expert insights from 2 rheumatologists.
Eye on Pharma: EC Approved Ustekinumab; Zymfentra Expansion; Biosimilar Policy Briefing
September 26th 2024The European Commission (EC) approved Celltrion's ustekinumab biosimilar for chronic inflammatory diseases, Celltrion expanded access to Zymfentra (subcutaneous infliximab-dyyb) through partnerships with Cigna and Express Scripts, and the Association for Accessible Medicines held a policy briefing addressing barriers to biosimilar adoption.
Insights from Festival of Biologics: Dracey Poore Discusses Cardinal Health’s 2024 Biosimilar Report
May 19th 2024The discussion highlights key emerging trends from the Festival of Biologics conference and the annual Cardinal Health Biosimilars Report, including the importance of sustainability in the health care landscape and the challenges and successes in biosimilar adoption and affordability.
Real-World Study Shows Comparable Outcomes Between CT-P13, Remicade in RA
September 14th 2024A real-world study of the biosimilar infliximab-dyyb (CT-P13; Inflectra) in rheumatoid arthritis (RA) reported the majority of patients who initiated CT-P13 switched from the reference product (Remicade) or another biologic or targeted synthetic disease-modifying antirheumatic drug.
Comparable Disease Activity, Drug Persistence in Patients With JIA Who Switch to Biosimilars
September 12th 2024Switching children with juvenile idiopathic arthritis (JIA) from anti–tumor necrosis factor originators to biosimilars showed similar disease activity and drug persistence, with good tolerability, supporting the safety and effectiveness of non-medical switching.
2 Commerce Drive
Cranbury, NJ 08512