Heart failure & cardiomyopathiesCohort study
Prior Authorization Requirements and Prescription Fill Patterns Among Patients With Heart Failure
- retrospective cohort study
- inverse probability weighting
Authors' conclusion
Prior authorization requirements were more common for patients identifying as Black or Hispanic and were associated with decreased and delayed filling of ARNI and SGLT2i. Our findings highlight an important barrier to mortality-reducing, guideline-recommended medications for HF.
Study context
- Population
- Patients with heart failure (HF) and a new prescription for ARNI or SGLT2i between April 1, 2021, and April 30, 2023, at a large, academic health systempatients, 1,243 with ARNI and 1,150 with SGLT2i prescriptions · ARNI 1,243 · SGLT2i 1,150
- Participants
- 2,183 patients
- Exposure
- prior authorization requirement vs no prior authorization requirement
Main finding
As reported in the abstract
Prior authorization requirement
ARNI, prior authorization requirement
12.2% (152/1,243)
SGLT2i, prior authorization requirement
14.3% (165/1,150)
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | P value |
|---|---|---|
| Time to fill and never filling — prior authorization requirement · weighted model | times longer to fill ARNI 3.03 (95% CI 2.16–4.25) | P < 0.001 |
| Time to fill and never filling — prior authorization requirement · weighted model | times longer to fill SGLT2i 6.75 (95% CI 4.44–10.3) | P < 0.001 |
| Time to fill and never filling — prior authorization requirement · weighted model | times more likely to never fill SGLT2i prescriptions 2.23 (95% CI 1.37–3.65) | P < 0.001 |
- Time to fill and never filling: all P < 0.001
Characteristics of patients requiring prior authorization
- Tended to be younger, identify as non-Hispanic Black or Hispanic, have non-Medicare insurance, and have fewer comorbidities
Original publication
Prior Authorization Requirements and Prescription Fill Patterns Among Patients With Heart Failure. JACC Adv. Published 24 January 2026. doi:10.1016/j.jacadv.2025.102583
Summarised from the published abstract; every number is checked against it