Insurance Hurdles Block Lifesaving Heart Drugs, Study Finds

NEW YORK, NY – March 11, 2026 – A stark new study reveals that a common insurance practice known as prior authorization is creating dangerous delays for heart failure patients seeking lifesaving medications, with the hurdles disproportionately affecting minority and low-income communities. The research, led by NYU Langone Health, provides damning evidence that these cost-control measures may be undermining patient health and widening existing health disparities.

Published in the journal JACC: Advances, the analysis focused on two pillars of modern heart failure treatment: angiotensin receptor-neprilysin inhibitors (ARNIs) and sodium-glucose cotransporter-2 (SGLT2) inhibitors. These drugs, which have no generic alternatives and can cost hundreds of dollars, have been proven to substantially reduce the risk of death. However, getting them into the hands of patients is proving to be a significant challenge.

According to the findings, heart failure patients whose prescriptions required prior approval from their insurer took three times as long to fill a prescription for an ARNI and a staggering six times as long to fill one for an SGLT2 inhibitor compared to those without this requirement. The consequences of these delays are severe. For SGLT2 inhibitors, patients facing prior authorization were twice as likely to give up entirely and never fill the prescription.

"Our results suggest that prior authorization may be doing harm when it comes to guideline-recommended medications with no generic alternatives," said Dr. Amrita Mukhopadhyay, the study's lead author and a cardiologist at NYU Grossman School of Medicine. "While these policies are meant to control health care costs by steering patients toward lower-priced alternatives, they may instead be keeping people with heart failure from timely access to lifesaving treatments."

The Human Cost of Administrative Hurdles

The study authors note that the process itself creates friction that leads to treatment abandonment. Most patients expect to fill a prescription the same day they visit their doctor. When a pharmacist informs them they must wait for an insurance approval that could take weeks, the momentum is lost. Some simply give up, while clinicians may hesitate to even prescribe a drug they know will trigger a burdensome approval process.

This phenomenon is not isolated to heart failure. Surveys from the American Medical Association (AMA) have consistently shown that physicians believe prior authorization harms patients. In recent surveys, over 90% of physicians reported that PA delays access to necessary care, and around 80% said it leads to patients abandoning their recommended course of treatment. Critically, nearly a quarter of physicians reported that a prior authorization struggle has led to a serious adverse event for a patient, including hospitalization, permanent impairment, or even death. This creates a paradox where a tool designed for cost control may inadvertently drive up long-term costs through disease progression and emergency interventions.

Reinforcing a Widening Health Divide

Perhaps the most alarming finding from the NYU Langone study is not just that delays are happening, but who is being delayed. The research team analyzed the electronic health records of over 2,100 patients and found a clear and disturbing pattern.

Prior authorization requirements were more frequently imposed on people living in lower socioeconomic-status neighborhoods, as well as on patients who identified as Black or Hispanic. Furthermore, patients with Medicaid insurance were more likely to face these barriers. This suggests the policy is not a neutral administrative tool but an active force exacerbating long-standing inequities in the American healthcare system.

"Our results indicate that prior authorization requirements may be contributing to the substantial health disparities seen in heart failure care and need to be carefully reexamined," stated Dr. Saul Blecker, the study's senior author and an associate professor at NYU Grossman School of Medicine.

These findings resonate with a larger body of research on health disparities. Racial and ethnic minorities already experience higher rates of heart failure and worse outcomes. By creating an additional barrier to the most effective, guideline-recommended therapies, prior authorization appears to be cementing this disadvantage. While insurance coverage through programs like Medicaid is designed to improve access, these administrative hurdles can negate the benefits, leaving the most vulnerable populations with delayed or denied care.

A System Under Scrutiny

The NYU study adds powerful, quantitative evidence to a long-simmering debate over the role of prior authorization in U.S. healthcare. While insurers, represented by groups like America's Health Insurance Plans (AHIP), defend the practice as a necessary tool to ensure treatments are medically appropriate and to control runaway costs, providers on the front lines describe a system drowning in administrative sludge.

The burden on medical practices is immense. AMA data reveals that physicians and their staff spend, on average, 12-13 hours per week—the equivalent of nearly two full workdays—just managing prior authorization requests. More than a third of physicians report hiring staff specifically for this purpose. This not only drives up practice costs but is a major contributor to physician burnout, as doctors are forced to spend time battling paperwork instead of caring for patients.

In response to mounting pressure from medical groups, patient advocates, and lawmakers, major insurers have repeatedly pledged to reform the process. Companies like UnitedHealthcare, Aetna, and Cigna have made public commitments to reduce the number of services requiring PA and to automate the process for faster decisions. However, many physicians remain deeply skeptical, noting that previous promises have yielded little meaningful change in their day-to-day work. The core issue remains: for high-cost specialty drugs like the ARNIs and SGLT2 inhibitors in the NYU study, which have no cheaper alternatives, the prior authorization process often feels less like a check for medical necessity and more like a tactic to delay or deter expensive, but life-altering, care.

Dr. Blecker cautioned that because the study was conducted within New York's health system, which has relatively comprehensive Medicaid coverage, the barriers linked to prior authorization may be even higher in other states. The research team plans to next explore how other insurance design elements, such as copays and coinsurance, further affect patient access to these critical heart failure drugs.