In dermatology, prior authorizations (PAs) can delay treatment, decrease patient adherence, and deter providers from advocating for their patients. Patients with complex dermatological conditions, often requiring off-label treatments, may face particularly significant insurance barriers.
Evaluate the impact of PAs in patients with complex dermatological conditions.
This prospective cohort study assessed patients seen by a dermatologist specializing in complex dermatology over 5 months. Patients included were >18 years old, seen at V.P.W.’s rheumatology-dermatology clinic, and prescribed a medication or ordered a diagnostic procedure that elicited an insurance PA. PA outcome, administrative time, and delay to treatment were collected.
Of 51 PAs, 51% were initially denied, with systemic medications more likely denied than topical medications (p <0.0001). Total administrative time spent on 50 PAs tracked was 62.5 hours (median time per PA: 30 minutes [IQR: 17-105]). Time to access treatment was tracked for 86% of PAs; median delay was 12 days [IQR: 5.5-23].
Single center, single provider patient panel.
Patients with complex dermatologic conditions face a significant barrier to care due to PAs. The administrative burden for provider practices to address these PAs is substantial and may warrant a streamlined system in collaboration with insurers.

Copyright © 2020. Published by Elsevier Inc.