Burden of Prior Authorization to the Provider and Cost to the Patient?

Objectives: The objective of this study is to report the early experience of a single institution prescribing vibegron by describing its associated time burden of prior authorizations (PA) to the provider and cost to the patient.

Methods: An institutional review board-approved retrospective review was performed for all patients prescribed vibegron by a single urologist from March 2021 to October 2022. Data was collected on patient demographics and insurance type, necessity for and time spent on PA by the provider, and patient cost for vibegron. Whether or not the patient filled the prescription given the out-of-pocket costs was also recorded.

Results: A total of 80 patients were included with a median age of 72 (IQR 60,79). 67.5% of patients required a PA with a median time required of 22.5 minutes (IQR 20,30). Four patients needing prior authorizations were denied coverage for medication, three had a successful appeal for coverage. The median price to patients requiring a PA for a 30-day supply of vibegron was $7.41 (IQR 0,121). The median price to patients not requiring a PA was $40 (IQR 3.3,116.5). The majority of patients had Medicare Fee-for-Service (41, 51.2%). 65.9% of Fee-for-Service (FFS) Medicare beneficiaries required a prior authorization, compared to 60.0% Medicaid, 80.0% private insurance and 40.0% for Medicare Advantage. There was no significant difference in the need for PA between the insurance types (p=0.3). Highest cost was noted with Medicare FFS ($40.5, IQR 1.4, 121.5) while the lowest median cost was with Medicaid($0, IQR 0,2.1). 51.2% of all patients filled their prescriptions. Furthermore, 26 patients stopped therapy with 17 ultimately progressing to 3rd line treatment.

Conclusions: Vibegron can be both expensive to obtain for patients and time-consuming to prescribe for providers. Furthermore, in our cohort only one third of patients went on to fill their prescription. While limited by a small sample size, our study provided data regarding real world experience prescribing a new, yet at times costly drug. Further studies on patient satisfaction of vibegron, continued prescribing patterns of vibegron and associated burden on providers are needed to best understand this shared experience moving forward.