OBJECTIVES: Venous thromboembolism (VTE) causes significant morbidity. Management of VTE includes oral anticoagulants (OAC) therapy. The study objective was to describe the magnitude of payer rejections and prescription abandonment, subsequent approved OAC claims, and factors associated with rejections among VTE patients newly prescribed OAC.

METHODS: This retrospective cohort study used data from IQVIA’s Formulary Impact Analyzer (FIA), Professional Fee Claims (Dx), and Hospital Charge Data Master (CDM) databases. Patients aged ≥18 years with VTE and newly prescribed an OAC (warfarin, apixaban, rivaroxaban, or dabigatran. First claim was index) between October 2016 and October 2021 were identified. Eligible patients had ≥1 claim in Dx and FIA in the first six months of the 1-year pre-index and the last 3 months of the 6-month follow-up periods. Patients with ≥2 prescriptions for different OACs on the index date or any paid OAC claims in the pre-index period were excluded. Index prescription status, reasons for rejections, subsequent approved claims and time to approvals were assessed descriptively. Multivariable logistic regression was used to identify factors associated with rejection of index OAC.

RESULTS: Of 297,312 patients identified, 9.1% had rejected index OAC. Majority of patients (82.1%) subsequently received an OAC, on average 18.3 days after rejection. Prior authorization (PA) requirement was the most common reason for rejections for dabigatran and rivaroxaban while ‘missing/incorrect information on the claim was most common for apixaban and warfarin. Index OAC type, insurance type, prescriber specialty, and diagnosis setting were significantly associated with index rejections. Among the 16.7% of patients with abandoned index OAC prescriptions, 75.9% subsequently received index OAC, on average 15.6 days after abandonment.

CONCLUSIONS: Rejections and abandonment may delay access to OAC treatment for VTE. Actionable information regarding the drivers of payer rejections can be helpful to mitigate the likelihood of rejections.