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Ella Leung, MD, a vitreoretinal surgeon at Georgia Retina, presented a study on the economic impact of anti-VEGF prior authorization requests at the 2025 annual meeting of the American Society of Retina Specialists (ASRS).
Her talk, titled, "Economic impact of anti-vascular endothelial growth factor prior authorization process," focused on the complex and burdensome process of obtaining prior authorizations for medical treatments.
The study revealed several key insights about the prior authorization process. While previous research showed a high approval rate for these requests, indicating that physicians are typically requesting anti-VEGF treatments for FDA-approved indications, the process itself creates significant challenges. These challenges manifest as substantial delays and administrative burdens for office staff and patients. This research uncovered that the economic impact is widespread and negative.
Contrary to potential expectations, the prior authorization process is not cost-saving for any stakeholder. Patients bear the greatest financial and time-related costs, but physicians, workplaces, and even insurance companies also experience increased expenses and inefficiencies. The study found that only in the least expensive scenarios might insurance companies potentially save money through prior authorizations. In most cases, the process actually increases overall costs and creates unnecessary complications for all parties involved.
Recognizing these challenges, Leung highlighted recent efforts by CMS and the Department of Health and Human Services to collaborate with insurers. Their goal is to reduce the burden and costs associated with prior authorization requests, which represents a promising step toward systemic improvement. The research serves as a call to action for healthcare professionals and policymakers to reevaluate and streamline the prior authorization process. By understanding the comprehensive economic impact, stakeholders can work towards creating a more efficient and patient-centered approach to medical treatment approvals.
Leung concluded her presentation by expressing hope for positive changes and thanking her co-authors and the ASRS Health Economics Committee for their contributions to this important research.
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