The Burden of Prior Authorizations for Pediatric Pulmonary Hypertension Medications: A Quantitative Assessment

This study quantified prior authorization (PA)-insurance-required approval-burden for pediatric pulmonary hypertension (PH) at an accredited center. Among 53 patients, 72% of 283 prescriptions between 2021 and 2023 required PA, with non-FDA-approved medications showing highest volume. Despite 97% approval and all patients ultimately obtaining medication, delays (mean 4.2 days), repeat requests (39%), and reliance on patient assistance programs created significant administrative burden. Results highlight the need for policy reform to ensure timely, equitable access to essential therapies.

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Publication Details

Journal
Pulmonary Circulation
Published
2025-10-01
DOI
https://doi.org/10.1002/pul2.70221
Primary Topic
Heart Failure Treatment and Management
Type
article
Field-Weighted Citation Impact
0.00
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article

The Burden of Prior Authorizations for Pediatric Pulmonary Hypertension Medications: A Quantitative Assessment

Kelly Merrill, Delphine Yung, Anne L. Davis
Pulmonary Circulation
Heart Failure Treatment and Management
article

The Burden of Prior Authorizations for Pediatric Pulmonary Hypertension Medications: A Quantitative Assessment

Kelly Merrill, Delphine Yung, Anne L. Davis
article en

Abstract

This study quantified prior authorization (PA)-insurance-required approval-burden for pediatric pulmonary hypertension (PH) at an accredited center. Among 53 patients, 72% of 283 prescriptions between 2021 and 2023 required PA, with non-FDA-approved medications showing highest volume. Despite 97% approval and all patients ultimately obtaining medication, delays (mean 4.2 days), repeat requests (39%), and reliance on patient assistance programs created significant administrative burden. Results highlight the need for policy reform to ensure timely, equitable access to essential therapies.

Pulmonary CirculationVol. 15(4)
Seattle Children's Hospital (US), University of Washington (US)
Openalex Percentile: Top 42%
Heart Failure Treatment and Management
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