In many cases, hypertriglyceridemia is multifactorial, resulting from a combination of genetic factors and other causes of increased triglyceride-rich lipoprotein production. It can also stem from a high calorie diet or uncontrolled diabetes – both risk factors affect a significant portion of the U.S. population today. Suffering from high triglyceride levels raises the risk of cardiometabolic conditions, including heart disease, stroke and diabetic neuropathy; it has also been linked to pancreatitis and fatty liver disease. Despite the known long-term complications, most cases of severe hypertriglyceridemia result from uncontrolled type 2 diabetes caused by a lack of routine monitoring after initial elevated triglyceride measurement.
Prior authorization (PA) requires healthcare providers to seek approval from a payer before certain medications or procedures will be covered. The PA process can be time-consuming and costly for clinicians, and may impact treatment strategies and patient care. In December 2017, the American Medical Association (AMA) fielded a web-based, 27-question survey distributed to 1,000 physicians. The national sample was comprised of 40% primary care physicians and 60% specialty physicians, all of whom provide 20 or more hours of patient care per week, and routinely complete prior authorizations (PAs) in their respective practices. The collective results of the survey indicated “the significant impact that prior authorization policies can have on both patients and physician practices.”
From a physician impact standpoint, 84% of physicians claim that the burden associated with PA for both physicians and staff is very high. Moreover, 86% report that PA burdens have increased over the past five years, with 51% reporting a ‘significant’ increase. Results further demonstrated that the average total PAs per physician each week totaled 29.1, translating into approximately 14.6 hours spent by physicians/staff to complete the workload. A staggering 79% of physicians claim that they are ‘sometimes, often, or always’ required to repeat PAs for prescription medications, when a patient is stabilized on a treatment regimen for a chronic condition.