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. 2020 Dec;83(6):1674-1680.
doi: 10.1016/j.jaad.2020.06.998. Epub 2020 Jul 2.

Evaluating the effect of prior authorizations in patients with complex dermatologic conditions

Olivia S Jew  1 , Joyce Okawa  2 , John S Barbieri  2 , Joanne McCaffrey  2 , Elizabeth Hayward  2 , Victoria P Werth  3
Affiliations

Evaluating the effect of prior authorizations in patients with complex dermatologic conditions

Olivia S Jew et al. J Am Acad Dermatol. 2020 Dec.

Abstract

Background: In dermatology, prior authorizations can delay treatment, decrease patient adherence, and deter providers from advocating for their patients. Patients with complex dermatologic conditions, often requiring off-label treatments, may face particularly significant insurance barriers.

Objective: Evaluate the effect of prior authorizations in patients with complex dermatologic conditions.

Methods: This prospective cohort study assessed patients treated by a dermatologist during 5 months who specialized in complex dermatology. Patients included were older than 18 years, treated at V.P.W.'s rheumatology-dermatology clinic, and prescribed a medication or ordered a diagnostic procedure that elicited an insurance prior authorization. Data on prior authorization outcome, administrative time, and delay to treatment were collected.

Results: Of 51 prior authorizations, 51% were initially denied, with systemic medications more likely denied than topical ones (P < .001). Total administrative time spent on 50 prior authorizations tracked was 62.5 hours (median time per prior authorization 30 minutes [interquartile range 17-105 minutes]). Time to access treatment was tracked for 80% of prior authorizations; median delay was 12 days [interquartile range 5.5-23 days].

Limitations: Single-center, single-provider patient panel.

Conclusion: Patients with complex dermatologic conditions face a significant barrier to care because of prior authorizations. The administrative burden for provider practices to address these prior authorizations is substantial and may warrant a streamlined system in collaboration with insurers.

Keywords: complex medical dermatology; health care delivery; prior authorizations.

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Conflict of interest statement

Conflicts of Interest and Notes: All authors have no conflicts of interest to report. The authors consent to publication. The authors confirm that all the research meets ethical guidelines, including adherence to the legal requirements of the study country. All information and materials in the manuscript are original.

Figures

Figure 1:
Figure 1:
Prior authorization workflow and outcomes
See this image and copyright information in PMC

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