Payer-Related Barriers With Therapies Used for Uncomplicated UTIs

Author(s):

Ryan Haumschild, PharmD, MS, MBA,Thomas M. Hooton, MD

Panelists discuss how recurrent urinary tract infections (UTIs) treated with older antibiotics generate 2 to 3 times higher total costs than initial savings, warranting cost-effectiveness analyses in treatment decisions, whereas payers create barriers to newer therapies through restrictive authorizations, high co-pays, step therapy mandates, and limited formulary inclusion that providers can navigate via detailed documentation, pharmacy benefit manager engagement, patient assistance programs, and advocacy for evidence-based coverage policies.

To what extent does the economic burden of recurrence in patients treated with older, more affordable drugs offset the initial cost savings, and how should this affect treatment decisions?
What payer-related barriers might arise for these emerging treatments for patients who have experienced treatment failure with traditional therapies?
How can health care providers advocate for their patients in these situations?