Dr Sabin Dang Discusses the Impact of Delayed Treatment in Retina Diseases – AJMC.com Managed Markets Network


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In retina surgery, obtaining prior authorization is an extra burden, and a delay in treatment for some of these patients could mean loss of vision, said Sabin Dang, MD, ophthalmologist with The Retina Institute.

In retina surgery, obtaining prior authorization is an extra burden, and a delay in treatment for some of these patients could mean loss of vision, said Sabin Dang, MD, ophthalmologist with The Retina Institute.

Transcript
Is there a common reason for prior authorization denial and are there best practices for preventing a denial?
What we have found in the field of ophthalmology and specifically retina surgery is we are incredibly successful at getting prior authorizations. So, when our field asks for a prior authorization, the data we collected in our study shows that we're successful in 99.5% of prior authorization requests. So, to say, is there a common reason for denials? There really isn't one. Bottom line is, when clinicians are asking to use the medication, it's done so appropriately.

When we dig into that 0.5% of denials, oftentimes those are very rare conditions that are potentially off label that are not very common. And those are the instances where we're seeing it. But the vast majority is definitely approved on the first go.

What impact are prior authorizations for anti–vascular endothelial growth factor (VEGF) medications having on patient treatment and outcomes?
With patients with retinal disease, oftentimes timing is very critical. These are often diseases that can be potentially blinding diagnoses, and timely treatment can give a patient better outcomes in the long run. We as clinicians do our best with a prior authorization landscape to obtain those authorizations and still provide timely treatment. But we do run into barriers.

For example, we could have an elderly patient who comes in with their family member and is diagnosed with a condition that requires treatment. We are unable to obtain prior authorization that day. So, we say, “Please come back. We're willing to see you tomorrow or the day after once we obtain prior authorization.” But the patient's family member may have already taken all the time off work they can that week, and they say, “Well, I'm sorry, we won't be able to come at least for another 1 to 2 weeks.” And if that's the best you can do, that's the best you can do. But you really are risking harm to that patient’s long-term vision in these situations.

So, it is a huge burden that we have now placed on patients and their family members by adding this one extra hurdle in the process.

What other potential issues could arise if care with anti-VEGF therapy is delayed due to prior authorizations?
If a patient has a delay in care, we do run the risk of permanent vision loss. That is the No. 1 concern we have as eye care providers is that a delay in treatment may lead to irreversible vision loss. Thankfully, we typically do have a few days, but that is not always the case. Sometimes we see patients with truly emergent pathology, where timing is critical. Where they require treatment within the next 24 hours in order to save their vision or even save their eye. So, it’s absolutely important that they receive timely treatment in order to get the best outcome.

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