Impact of Prior Authorization Suspension on Access to Diabetes Technology in an Underserved Population: A Retrospective Analysis.

Abstract

Because of a computer-based prior authorization (PA) centralized system failure, Medi-Cal authorities temporarily suspended PA requirements for continuous glucose monitoring (CGM) and insulin pumps, including automated insulin delivery systems, for 18 months. We assessed whether this PA-free period improved access to diabetes technology or impacted glycemic control. We conducted a retrospective chart review of 105 adults with type 1 diabetes in a safety net clinic across two sequential policy periods: PA-required and PA-free. Observational outcomes included device prescriptions, delays, denials, device receipt, and HbA1c. Paired t tests (α = 0.05) assessed HbA1c changes; descriptive statistics summarized access. Definitions for delay and access outcomes were standardized a priori. During the PA-required period, 32 CGM prescriptions were written; 46% were delayed (mean: 82 days), and 21% were denied. During the PA-free period, 27 new CGM prescriptions were written; approvals increased, and mean delay decreased to 40 days, although delays persisted. CGM use increased from 36.2% to 81.0%, and pump use increased from 16 to 25 patients. Mean HbA1c decreased from 9.1%, 76 mmol/mol (SD = 2.16), to 8.5%, 69 mmol/mol (SD = 1.89) (P = 0.032). Removal of PA requirements was associated with improved access to diabetes technology and clinically meaningful HbA1c reductions. Residual barriers highlight persistent structural inequities. Findings support policies that reduce administrative burden for clinically indicated populations.