Characteristics of prior authorization policies for new drugs in Medicare Part D

Health insurance providers in the US can employ prior authorization (PA), for which approval from the insurer is needed before a prescription can be dispensed. Prior authorization is most prevalent among expensive or complex therapies to ensure appropriate use. Physicians report that PA can be administratively burdensome.1,2 In Medicare Part D, drug benefits are administered by a multitude of private plans, each with its own formulary and benefit design. An earlier study found that most new drugs covered in Part D are subject to PA requirements, primarily due to high launch prices.3 However, characteristics of such requirements have not been examined. We sought to describe the characteristics of PA policies for new drugs in Part D to understand whether they are consistent with US Food and Drug Administration (FDA) indications.