Prior Authorization Delays Heart Failure Drug Access: Study

A routine administrative process – prior authorization – may be creating dangerous delays in access to critical medications for people living with heart failure, according to a fresh study published March 11, 2026. The research, led by NYU Langone Health, focuses on two classes of drugs, angiotensin receptor-neprilysin inhibitors (ARNIs) and sodium-glucose cotransporter-2 (SGLT2) inhibitors, which have become essential components of modern heart failure treatment.

The Authorization Hurdle

Prior authorization requires physicians to obtain approval from health insurance companies before certain treatments are covered. While intended to control healthcare costs, the study suggests this process may be inadvertently harming patients. Both ARNIs and SGLT2 inhibitors currently lack generic alternatives, meaning they can be expensive for patients if they have to pay out-of-pocket. These medications are proven to substantially reduce the risk of death when added to standard heart failure therapy, yet past research indicates less than half of patients prescribed them take them consistently.

The NYU Langone Health analysis found that individuals with heart failure whose prescriptions required prior authorization took three times as long to fill an ARNI prescription and six times as long to fill an SGLT2 inhibitor prescription compared to those without this requirement. Alarmingly, patients whose SGLT2 prescriptions needed prior approval were twice as likely to abandon filling them altogether. NYU Langone Health News reports these findings highlight a potential disconnect between cost-control measures and patient well-being.

Understanding the Medications

Heart failure is a complex condition where the heart can’t pump enough blood to meet the body’s needs. ARNIs and SGLT2 inhibitors function through different mechanisms to improve heart function and reduce the risk of hospitalization and death. ARNIs, like sacubitril/valsartan (Entresto), combine two types of medications to relax blood vessels and reduce strain on the heart. SGLT2 inhibitors, originally developed for diabetes, have been shown to benefit heart failure patients by helping the kidneys remove excess fluid and sodium. JACC Advances provides further detail on these medications and their role in heart failure management.

Why the Delays?

The study authors suggest several factors contribute to these delays. Most patients attempt to fill prescriptions immediately following a medical visit. The prior authorization process, though, introduces an additional administrative step that can disrupt this timely access. The need for documentation, appeals, and communication between physicians and insurance companies can create significant bottlenecks. This is particularly concerning given the critical nature of these medications for patients with heart failure.

Study Details and Limitations

The research, led by cardiologist Amrita Mukhopadhyay, MD, analyzed prescription fill patterns. Dr. Mukhopadhyay is the Eugene Braunwald, MD, Assistant Professor of Cardiology in NYU Grossman School of Medicine’s Department of Medicine and its Leon H. Charney Division of Cardiology. While the study demonstrates a clear association between prior authorization and delayed/abandoned prescriptions, it’s important to note that it does not prove causation. Other factors, such as patient adherence, socioeconomic status, and access to transportation, could also play a role. The study did not investigate the reasons for denial of prior authorization requests, which would be a valuable area for future research.

Beyond the Numbers: The Patient Perspective

The implications of these delays extend beyond mere inconvenience. For individuals with heart failure, even short interruptions in medication can lead to worsening symptoms, increased hospitalizations, and a higher risk of mortality. The financial burden of these medications, coupled with the administrative hurdles of prior authorization, can create significant stress and anxiety for patients and their families. The study underscores the need for a more streamlined and patient-centered approach to medication access.

What’s Driving the Trend Towards Prior Authorization?

Prior authorization is increasingly common as health insurers seek to manage costs. The practice is intended to ensure that medications are used appropriately and that patients are receiving the most cost-effective treatments. However, critics argue that it places an undue burden on physicians and patients, and that it can delay access to necessary care. A press release from PR Newswire details the growing concerns surrounding this practice.

The Cost Factor

The lack of generic alternatives for ARNIs and SGLT2 inhibitors is a key driver of the cost concerns. These medications can cost hundreds of dollars per month, making them unaffordable for some patients without insurance coverage or substantial financial assistance. Insurance companies may require prior authorization to ensure that these medications are only prescribed to patients who meet specific criteria.

Looking Ahead: Potential Solutions

The study’s findings suggest a need to re-evaluate the use of prior authorization for guideline-recommended medications with no generic alternatives. Potential solutions include streamlining the prior authorization process, reducing the administrative burden on physicians, and increasing transparency in coverage decisions. Further research is needed to understand the impact of prior authorization on patient outcomes and to identify best practices for ensuring timely access to essential medications. Ongoing monitoring of prescription fill patterns and patient experiences will be crucial in assessing the effectiveness of any interventions.