Project Grant R01HL185247

The National Heart, Lung, and Blood Institute awarded the University of Pennsylvania $685,212 on August 15, 2026, under the Cardiovascular Diseases Research program (CFDA 93.837) to develop policy-relevant evidence on the scope and effects of prior authorization (PA) for cardiovascular care.

The project quantifies patient exposure to PA for cardiovascular services from 2016 through 2024, identifying which patient groups experience PA barriers and measuring how PA affects service use, care delays, and health outcomes. The research leverages administrative data from UnitedHealth, the nation's largest Medicare Advantage insurer, including PA policies, medical claims, and enrollment data for Medicare Advantage and commercial plans. The study exploits a natural experiment: in 2017, UnitedHealth implemented a PA reduction pilot across 71 Medicare Advantage plans in 9 states, eliminating PA requirements for over 300 services, with the most substantial reductions targeting cardiovascular-related services such as echocardiography. This quasi-experimental design generates causal evidence on PA's effects on cardiovascular service delivery and patient outcomes.

Work is performed in Philadelphia, Pennsylvania, with a performance period extending through April 30, 2030. The assistance type is a project grant.