Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access |
Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc |
Journal website https://www.jofem.org |
Original Article
Volume 14, Number 4, August 2024, pages 159-165
Trends in Teprotumumab Insurance Authorization and Socioeconomic Determinants of Teprotumumab Access
Tables
PA approved (N = 80) | PA not approved (N = 13) | P value | |
---|---|---|---|
*P < 0.05. PA: prior authorization. | |||
Age at visit prior to teprotumumab request (mean, median (range)) | 57, 60.5 (21 - 82) | 52, 52 (32 - 70) | 0.26 |
Biologic sex | 0.47 | ||
Male | 64 (80%) | 9 (69%) | |
Female | 16 (20%) | 4 (31%) | |
Race/ethnicity | |||
White | 52 (65%) | 10 (77%) | |
Asian | 8 (10%) | 0 | |
African American | 7 (9%) | 0 | |
Hispanic/Latino | 9 (10%) | 2 (15%) | |
Other | 2 (3%) | 0 | |
Unknown | 2 (3%) | 1 (8%) | |
Employment status | 0.22 | ||
Employed or student | 23 (29%) | 5 (38%) | |
Unemployed | 35 (44%) | 2 (16%) | |
Unemployed | 6 (8%) | 1 (8%) | |
Disabled | 7 (9%) | 0 | |
Retired | 22 (28%) | 1 (8%) | |
Unknown | 22 (28%) | 6 (46%) | |
Distance to clinic (miles) (mean, median (range)) | 41, 23 (2 - 377) | 83, 44 (15 - 263) | 0.02* |
Median income by zip code ($) (median (range)) | 58,738 (27,379 - 117,700) | 60,884 (28,963 - 100,308) | 0.72 |
Insurance type | 0.003* | ||
Medicare | 30 (38%) | 0 | |
Private | 31 (39%) | 5 (38%) | |
Medi-Cal | 16 (20%) | 8 (62%) | |
Federal | 3 (4%) | 0 | |
Secondary insurance | 0.1 | ||
Yes | 25 (31%) | 1 (8%) | |
No | 55 (69%) | 12 (92%) |
PA approved (N = 80) | PA not approved (N = 13) | P value | |
---|---|---|---|
CAS: clinical activity score; PA: prior authorization. | |||
Average CAS (mean, median (range)) | 5.5, 5 (1 - 10) | 5.7, 6 (2 - 8) | 0.68 |
Current smoker | 0.27 | ||
Yes | 14 (18%) | 4 (31%) | |
No | 66 (83%) | 9 (69%) | |
Disease phase | 0.51 | ||
Active | 68 (85%) | 11 (85%) | |
Stable | 15 (15%) | 2 (15%) | |
Prior treatment tried | > 0.99 | ||
Yes | 32 (40%) | 5 (38%) | |
No | 48 (60%) | 8 (52%) | |
If prior treatment tried, type | Of 32 patients | Of 5 patients | |
Radiotherapy | 3 (9%) | 0 | |
Pulse steroids | 7 (22%) | 3 (60%) | |
Oral steroids | 13 (41%) | 3 (60%) | |
Decompression surgery | 11 (34%) | 2 (40%) | |
Strabismus surgery | 3 (9%) | 0 | |
Lid surgery | 5 (16%) | 0 | |
Other | 1 (3%) | 0 | |
Year of approval/denial | Approval | Denial | |
2019 | 2 (3%) | - | |
2020 | 33 (41%) | 5 (38%) | |
2021 | 14 (18%) | 5 (38%) | |
2022 | 14 (18%) | 2 (15%) | |
2023 | 17 (21%) | 1 (8%) | |
If denied, reason for denial | |||
Thyroid Labs > 30 days ago | - | 4 (31%) | |
Administrative error | - | 3 (23%) | |
No oral steroids trial | - | 3 (23%) | |
Facility out of network | - | 2 (15%) | |
Patient not euthyroid | - | 2 (15%) | |
CAS too low | - | 2 (15%) | |
Smoking status | - | 2 (15%) | |
No endocrinology evaluation | - | 1 (8%) | |
Limited visual potential | - | 1 (8%) | |
Not medically necessary | - | 1 (8%) | |
If denied, subsequent approval? | |||
Yes | - | 10 (77%) | |
Days to approval (mean, median (range)) | - | 138, 57 (1 - 476) | |
No | - | 2 (15%) | |
Unknown | - | 1 (8%) |