Prior authorization

Elaine C. Wirrell, Alexander J. Vanderwiel, Lauren Nickels, Saskia L. Vanderwiel and Katherine C. Nickels. Impact of Prior Authorization of Anti-Epileptic Drugs in Children with Epilepsy.  Pediatric Neurology.  In press.

Abstract

Objective

To assess how commonly prior authorization (PA) results in treatment delay or missed doses in children with epilepsy.

Methods

A survey was sent to parents of 462 children followed in a pediatric epilepsy clinic over a 10 month period. Epilepsy and insurance details were collected. Parents were asked if PA for AEDs was required in the prior year, and if so, whether it led to either (1) delayed initiation of a newly-prescribed AED, and/or (b) a lapse in coverage of a current AED. PA was defined as smooth if there was a <7 day delay in starting a new AED and no lapse in coverage of a current AED.

Results

164 families (35%) returned completed surveys. Mean age was 11.2 (SD 5.3) years and 67.4% had seizures >q3months despite trials of ≥2 AEDs. 136 (82.9%) had private primary insurance whereas 25 (15.2%) were on Medicaid.

PA was required in 63 (38.4%) cases, and proceeded smoothly in only 31 (49.2%). 23 children experienced a delay of >7 days in starting a new AED, and 24 a lapse in coverage of their current AED (11-missed dose, 12-parents paid out of pocket to avoid missed dose, 1-accessed AED through patient assistance program). 7/11 who missed AED doses had increased seizures, and one required hospital admission for status epilepticus.

Conclusions

PA of AEDs is common but problematic, often resulting in either delay of initiation of a new AED or lapse in coverage of a currently-used AED, with a negative impact on seizure control.