Administrative costs of prior authorizations for glucagon-like peptide-1 agonists.

Abstract

Prior authorizations (PAs) help ensure appropriate prescription drug use but can be time-consuming for prescribers, clinic staff, and patients. Having a centralized, pharmacy-led PA process has shown significantly lower time to approval when compared with other decentralized models. However, the administrative impact of processing PA requests for glucagon-like peptide-1 (GLP-1) agonists prescribed for weight loss is unknown. To compare the total staff time spent on GLP-1 agonists prescribed for weight loss vs GLP-1 agonists for diabetes and other prescription medications. This prospective observational study was conducted at UC Davis Health, a large academic health system from October 2024 to April 2025. Six licensed pharmacy technicians from a centralized pharmacy PA team participated in a self-reported time survey. PA tasks were categorized into 3 groups: (1) GLP-1 agonists for weight loss, (2) GLP-1 agonists for diabetes, and (3) top 10 non-GLP-1 agonist medications processed by volume at UC Davis Health. The primary outcome is defined as total hands-on time per PA, measured from PA initiation to removal from the pharmacy technician's work queue following the final decision by the third-party payer. A sample size of 50 PAs per group was selected based on projected mean PA process times of 10 minutes for weight loss GLP-1 agonists and 7 minutes for diabetes GLP-1 agonists (β = 0.2, α = 0.05). The Mann-Whitney U-test was applied to compare continuous variables (hands-on time, cost), whereas the Fisher's exact test was used for dichotomous variables (approval rate). A total of 150 PAs were collected. A self-reported time survey showed that weight loss GLP-1 agonists were associated with a significantly higher mean time per PA (7.1 minutes; 95% CI = 3.4-10.8; <i>P</i> < 0.0001), lower approval rate at 48% vs 90% (odds ratio [OR] = 0.10, 95% CI = 0.04-0.31; <i>P</i> < 0.0001), and higher mean cost per PA ($6.74; 95% CI = 3.21-10.27) compared with diabetes GLP-1 agonist medications. The PA process for weight loss GLP-1 agonists was longer (7.2 minutes; 95% CI = 3.3-11.1), more costly ($6.77; 95% CI = 3.08-10.46), and less likely to be approved (48% vs 90%; OR = 0.17; 95% CI = 0.07-0.44) compared with non-GLP-1 agonist medications. There were no differences between the diabetes GLP-1 agonist and top 10 non-GLP-1 agonist medications. Total hands-on time spent on GLP-1 agonists prescribed for weight loss was significantly longer compared with GLP-1 agonists for diabetes and other non-GLP-1 agonist medications. Additionally, GLP-1 agonists for weight loss had lower approval rates and higher cost per PA.