Examining the Prevalence of Prior Authorizations for Use of PARP Inhibitors in Ovarian Cancer
Clinical data has demonstrated that the use of poly (ADP-ribose) polymerases (PARP) inhibitors improve survival in ovarian cancer, particularly in patients with BRCA 1/2 mutations or homologous recombination deficiency (HRD). The FDA-approved drugs cost $100,000 annually on average, and concerns have been expressed about insurance barriers like prior authorization to medications such as the PARP inhibitors.
In the study, Dr Audra Hugo, University of Pennsylvania, Philadelphia, PA. and colleagues used electronic medical records and examined the prevalence of prior authorization for PARP inhibitors overall, by frontline or recurrent maintenance, and by BRCA or HRD status. They then evaluated the associated approval and appeal rates.
In the study, researchers conducted a retrospective cross-sectional study of ovarian cancer patients prescribed a PARP inhibitor within the University of Pennsylvania oncology practices from May 2020-2021.
Researchers identified 110 patients with ovarian cancer who were prescribed a PARP inhibitor. Of these, 67% (95%CI 57-75) experienced prior authorization for their PARP inhibitor. In contrast, 31% (95%CI 23-40) experienced prior authorization for other components of their gynecologic oncology care. Of patients in the frontline setting, 74% (95%CI 58-86) experienced prior authorization for FDA-approved PARP maintenance.
Of patients prescribed PARP maintenance after recurrence, 58 (95%CI 45-71) experienced prior authorization. Of patients with germline BRCA, 70% (95%CI 47-85) experienced prior authorization for PARP inhibitors. Of patients with germline or somatic BRCA or HRD+, 76% (95%CI 61-87) experienced prior authorization. 95% (95%CI 86-94) of prior authorizations for PARP inhibitors were approved on their 1st appeal, and 99% (95%CI 95-100) were approved by the 2nd appeal.
The authors concluded that an estimated two-thirds of ovarian cancer patients who were prescribed PARP inhibitor experienced prior authorization, including equally elevated rates among women with germline or somatic BRCA mutations, as well as with HRD-deficient tumors. They also noted that due to the almost 100% approval after prior authorization, enhancements in insurance processes are necessary to simplify PARP inhibitor access in ovarian cancer.
Resource:
Hugo A, Pena D, Ko E, Haggerty A, et al. Prior authorizations for PARP inhibitors in ovarian cancer. Abstract presented at: ASCO Annual Meeting; June 3-7, 2022; Chicago, IL, and virtual. Abstract 5549.
