Ironically, “in an effort to decrease costs for an employer-purchased insurance, the insurers actually make patients take more time away from work, thereby negatively impacting the employees’ economic contribution to the employer,” said Dr. Orlandi.
CT scans of the neck or sinuses, new technology such as a hypoglossal nerve sinus implant to treat sleep apnea, and balloon dilation in the Eustachian tube and sinus have very specific criteria that often require peer-to-peer review for prior authorization. Certain medications, such as the newer monocolonal antibody biologics used for asthma and CRS with polyps, also trigger prior authorization due to their expense, said Dr. Orlandi.
“These typically go through a robust prior authorization process, and it’s not uncommon for the request to be rejected,” he added. “Sadly, these patients may have exhausted all other options, and [this has a] significant impact on quality of life. The need to control this expensive treatment and the need to improve these patients’ health needs to be better balanced.”
Cheryl Alkon is a freelance medical writer based in Massachusetts.