FRIDAY, March 13, 2026 (HealthDay News) -- For patients with heart failure, prior authorization is associated with reduced and delayed filling of prescriptions for angiotensin receptor neprilysin inhibitors (ARNIs) and sodium glucose cotransporter 2 inhibitors (SGLT2is), according to a study published in the Feb. 1 issue of JACC: Advances.
Amrita Mukhopadhyay, M.D., from NYU Grossman School of Medicine in New York City, and colleagues conducted a retrospective cohort study using electronic health record, pharmacy fill, and neighborhood-level data to examine whether prior authorizations were associated with delayed or decreased filling for ARNIs and SGLT2is among 2,183 patients with heart failure.
Overall, 12.2 and 14.3 percent of 1,243 and 1,150 patients, respectively, had a prior authorization requirement for an ARNI or SGLT2i. Prior authorization was required for patients who tended to be younger, identify as non-Hispanic Black or Hispanic, have non-Medicare insurance, and have fewer comorbidities. In weighted models, patients requiring prior authorization took 3.03 and 6.75 times longer to fill ARNI and SGLT2i prescriptions, respectively, and were 2.23 times more likely to never fill prescriptions for an SGLT2i.
"Our results suggest that prior authorization may be doing harm when it comes to guideline-recommended medications with no generic alternatives," Mukhopadhyay said in a statement. "While these policies are meant to control health care costs by steering patients toward lower-priced alternatives, they may instead be keeping people with heart failure from timely access to lifesaving treatments."
One author disclosed financial ties to Abbott Vascular, Philips, and Siemens.