{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T07:14:03Z","timestamp":1788246843152,"version":"build-2803163510"},"reference-count":23,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Haemophilia"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Prior authorizations (PAs) are widely used to control healthcare costs and ensure appropriate use of high\u2010cost therapies, but they often create undue administrative burdens. In haemophilia care, timely access to specialty medications is critical, yet Haemophilia Treatment Centres (HTCs) must frequently navigate payer\u2010driven PA requirements that can delay treatment and disrupt care delivery. To our knowledge, this study is the first of its kind to examine how the PA process affects patient care and provider workloads in HTCs<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty staff from federally designated HTCs across the United States were purposively recruited to participate in virtual, semi\u2010structured interviews. Eligible participants were directly involved in the PA process. Interviews were recorded, transcribed, and de\u2010identified. Data were analyzed using conventional content analysis with independent coding by two investigators, supported by Dedoose software. Descriptive statistics summarized participant characteristics, and the labour\u2010time and cost estimate was estimated by annualizing labour costs using mean weekly hours spent on PAs and position\u2010specific wage rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A thematic analysis revealed four themes related to PA challenges and the burden on care delivery. The mean weekly time spent on PAs was 6.5 h per participant. Eighty\u2010five percent of participants reported burnout related to PAs. The labour\u2010time and cost estimate per participant\u2010year spent on PAs ranged from $4795 (nurse practitioner) to $20,718 (non\u2010clinical staff).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings emphasize the need for efficient, clinically informed PA processes to reduce administrative burden and care delays, and identify a need for further education for insurers, potentially at the national level.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hae.70381","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:29:59Z","timestamp":1788244199000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Burden of Prior Authorizations in Bleeding Disorder Specialty Drugs"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0340-0045","authenticated-orcid":false,"given":"Lisa","family":"Littner","sequence":"first","affiliation":[{"name":"Medical University of South Carolina Charleston South Carolina USA"},{"name":"Division of Hematology Cancer and Blood Disease Institute Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0800-0868","authenticated-orcid":false,"given":"Jami","family":"Jones","sequence":"additional","affiliation":[{"name":"College of Health Professions Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5565-3346","authenticated-orcid":false,"given":"Trudie","family":"Milner","sequence":"additional","affiliation":[{"name":"College of Health Professions Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5669-0934","authenticated-orcid":false,"given":"Elinor","family":"Borgert","sequence":"additional","affiliation":[{"name":"College of Health Professions Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"issue":"11","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1002\/pds.4893","article-title":"Initiation of Generic imatinib May Improve Medication Adherence for Patients With Chronic Myeloid Leukemia","volume":"28","author":"Cole A. L.","year":"2019","journal-title":"Pharmacoepidemiology and Drug Safety"},{"issue":"15","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1001\/jama.2022.17732","article-title":"Improving Prior Authorization in Medicare Advantage","volume":"328","author":"Anderson K. E.","year":"2022","journal-title":"JAMA"},{"issue":"6","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1086\/655890","article-title":"Uncompensated Medical Provider Costs Associated With Prior Authorization for Prescription Medications in an HIV Clinic","volume":"51","author":"Goldstein E. L.","year":"2010","journal-title":"Clinical Infectious Diseases"},{"issue":"4","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1177\/0897190021997007","article-title":"Embedding an Advanced Pharmacy Technician in an Adult Specialty Pulmonary Clinic to Complete Prior Authorizations Improves Efficiency and Provider Satisfaction","volume":"35","author":"Jones E. M.","year":"2022","journal-title":"Journal of Pharmacy Practice"},{"issue":"2","key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1046\/j.1365-2516.2001.00484.x","article-title":"Home\u2010Based Factor Infusion Therapy and Hospitalization for Bleeding Complications Among Males With Haemophilia","volume":"7","author":"Soucie J. M.","year":"2001","journal-title":"Haemophilia"},{"issue":"6","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1111\/hae.13558","article-title":"Prophylaxis Re\u2010Visited: The Potential Impact of Novel Factor and Non\u2010Factor Therapies on Prophylaxis","volume":"24","author":"Carcao M.","year":"2018","journal-title":"Haemophilia"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"897","DOI":"10.2147\/JBM.S325031","article-title":"Integrated Hemophilia Patient Care Via a National Network of Care Centers in the United States: A Model for Rare Coagulation Disorders","volume":"12","author":"Valentino L. A.","year":"2021","journal-title":"Journal of Blood Medicine"},{"issue":"11","key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"1970","DOI":"10.1377\/hlthaff.2019.01830","article-title":"Net Spending on Retail Specialty Drugs Grew Rapidly, Especially for Private Insurance and Medicare Part D","volume":"39","author":"Hill S. C.","year":"2020","journal-title":"Health Affairs"},{"issue":"6","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","DOI":"10.1002\/pbc.26339","article-title":"Medication Prior Authorization in Pediatric Hematology and Oncology","volume":"64","author":"Dickens D. S.","year":"2017","journal-title":"Pediatric Blood & Cancer"},{"issue":"1","key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.jaad.2020.07.095","article-title":"Impact of Prior Authorizations on Dermatology Patients: A Cross\u2010Sectional Analysis","volume":"85","author":"Guo L. N.","year":"2021","journal-title":"Journal of the American Academy of Dermatology"},{"key":"e_1_2_11_12_1","unstructured":"\u201cEmergency Department Management Guidelines | NBDF \u201dNational Bleeding Disorders Foundation. December 2019."},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13023\u2010021\u201001774\u20109"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2023.29.6.647"},{"issue":"1","key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1007\/s00246-023-03255-1","article-title":"Burden With no Benefit: Prior Authorization in Congenital Cardiology","volume":"45","author":"Marcus B. S.","year":"2024","journal-title":"Pediatric Cardiology"},{"issue":"9","key":"e_1_2_11_16_1","doi-asserted-by":"crossref","DOI":"10.1093\/haschl\/qxae096","article-title":"Perceptions of Prior Authorization Burden and Solutions","volume":"2","author":"Sahni N. R.","year":"2024","journal-title":"Health Affairs Scholar"},{"key":"e_1_2_11_17_1","unstructured":"United States Hemophilia Treatment Center Network \u201cWho We Are \u201d2025.https:\/\/ushtcnetwork.org\/who\u2010we\u2010are\/."},{"key":"e_1_2_11_18_1","unstructured":"Centers for Disease Control and Prevention \u201cHemophilia Treatment Center (HTC) Directory \u201d2025 https:\/\/dbdgateway.cdc.gov\/HTCDirSearch.aspx."},{"issue":"9","key":"e_1_2_11_19_1","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1177\/1049732305276687","article-title":"Three Approaches to Qualitative Content Analysis","volume":"15","author":"Hsieh H.\u2010F.","year":"2005","journal-title":"Qualitative Health Research"},{"key":"e_1_2_11_20_1","unstructured":"U.S. Department of Labor and Statistics \u201cOccupational Outlook Handbook \u201d2025.https:\/\/www.bls.gov\/ooh\/healthcare\/."},{"key":"e_1_2_11_21_1","unstructured":"American Medical Association(2024). \u201cAMA Prior Authorization Physician Survey \u201dhttps:\/\/www.ama\u2010assn.org\/system\/files\/prior\u2010authorization\u2010survey.pdf."},{"issue":"2","key":"e_1_2_11_22_1","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.cgh.2023.06.021","article-title":"Prior Authorizations Delay Therapy, Impact Decision\u2010Making, and Lead to Adverse Events in Inflammatory Bowel Disease: 2022 Provider Survey","volume":"22","author":"Constant B. D.","year":"2024","journal-title":"Clinical Gastroenterology and Hepatology"},{"issue":"6","key":"e_1_2_11_23_1","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1016\/j.jaad.2019.05.024","article-title":"Examining the Prior Authorization Process, Patient Outcomes, and the Impact of a Pharmacy Intervention: A Single\u2010Center Review","volume":"81","author":"Popatia S.","year":"2019","journal-title":"Journal of the American Academy of Dermatology"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995\u2010018\u20102545\u20107"}],"container-title":["Haemophilia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hae.70381","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/hae.70381","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hae.70381","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:30:03Z","timestamp":1788244203000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hae.70381"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":23,"alternative-id":["10.1111\/hae.70381"],"URL":"https:\/\/doi.org\/10.1111\/hae.70381","archive":["Portico"],"relation":{},"ISSN":["1351-8216","1365-2516"],"issn-type":[{"value":"1351-8216","type":"print"},{"value":"1365-2516","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]},"assertion":[{"value":"2026-04-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"hae.70381"}}