Cost containment by peer prior authorization program for second line treatment in patients with retinal disease
Abstract Background: Rising drug prices prompt the establishment of cost-containment treatment policies. Ranibizumab was approved for treatment of retinal diseases, although the less-costly, off label, bevacizumab has been found equally effective. We describe a novel prior-authorization approach, which we applied to ranibizumab as second-line treatment, in non-responders to first-line bevacizumab: A steering committee set the funding criteria based on cost and updating clinical considerations; an ophthalmic specialists team evaluated their colleagues’ individual patient subsidization request, based on the funding criteria. Methods This retrospective cohort included all the applications for a first or ongoing treatment with ranibizumab, for one or both eyes, applying for treatment between March 1, 2012 to December 31, 2015 During that time, 16,778 applications for funding from 5,642 patients (~2.97 applications/patient) were submitted and assessed, accounting for 31% of bevacizumab (first line)-treated patients Aapproval was granted in 94.6% of all requests, via their peer-revision. Conclusions The program made it feasible to finance a costly treatment for patients that may benefit from it, while maintaining qualitative medical outcomes and sparing treating ophthalmologist from ethical gatekeeping dilemmas