Automated Versus Manual Prior Authorization for Type 2 Diabetes Mellitus Drugs: A Retrospective Study From Israel

OBJECTIVES: Drug prior authorization (PA) imposes significant bureaucratic and economic burden on healthcare providers and payers. A novel automated PA system developed by Meuhedet, a large health maintenance organization in Israel, may improve these drawbacks.

METHODS: A historical cohort study compared manual versus automated PA mechanisms for type-2 diabetes mellitus (T2DM) drugs: Sodium-Glucose co-transporter-2 inhibitors (SGLT2i) and Glucagon-like Peptide-1 analogs (GLP1-A). The intervention group included patients with diabetes mellitus, whose first drugs applications were approved according to Israeli health basket criteria using the novel automated system, whereas the control group's similar applications were approved by manually by PA centers' staff. The primary endpoint was the time elapsed from application to prescription's fulfillment (accessibility time). Secondary endpoints included prescription fulfillment rate at 7 and 30 days; change in manual applications number following the automated system's introduction; and direct costs savings attributed to the automated PA operation.

RESULTS: 1371 automated approved prescriptions and 1240 manually approved prescriptions were included in the analysis. Median accessibility time was 1 day (IQR 0-5) with automated PA for both GLP1-A and SGLT2i, compared with 4 days (IQR 1-9) and 3 days (IQR 1-8), respectively, with the manual PA (p <0.001). 84% of GLP1-A automated PA approvals were filled within 7 days compared with 70% with manual PA (p<0.001). Similar results were seen with SGLT2i (80% vs. 72%, p<0.008). No differences were observed at 30 days post-approval. Using logistic regression, odds for GLP1-A and SGLT2i prescription fulfillment within 7 days were 2.36 and 1.53 folds higher (respectively) with the automated system (p<0.01). The automated PA system reduced the total number of manual PA applications by 40%, cutting annual administrative costs by 566,000 US dollars.

CONCLUSIONS: Automated PA system improved access time to SGLT2i/GLP1-A 7 days post approval compared to manual PA, while significantly reducing workload and economic burden of manual applications.