Prior Authorizations Place Burden, Reduce Quality of Care in Dermatology Patients

A doctor filling out a prescription form
A doctor filling out a prescription form
Prior authorizations create administrative burden for dermatologists, delays in patient care, and negative patient outcomes.

A study found that current prior authorizations (PAs) employed by insurers place a time burden on clinicians and may delay the time it takes for dermatology patients to receive their prescriptions. In addition, PA denials in these patients may be associated with reduced improvement in disease compared with patients with PA approvals. Findings from the study were published in the Journal of the American Academy of Dermatology.

Adult patient visits that included ≥1 prescription and required a PA at a general dermatologic visit were included in the retrospective study. The researchers of the study reviewed clinic visits and PAs before pharmacy intervention (May 1, 2017-July 31, 2017; n=10,092) and after pharmacy intervention (October 1, 2017-December 31, 2017; n=9039).

In the prepharmacy intervention phase, full-time medical assistants used 50% of their work day handling PAs, whereas 1 full-time pharmacy technician oversaw PAs 100% of her time. All PAs were submitted within a 1-day period of receipt, and technicians made sure decisions were made within 3 days.

Among all dermatological prescriptions, up to 8.1% required a PA. The most common types of medications that required a PA included topical steroids, topical antibiotics and antifungals, and topical retinoids, whereas the most common indications included acne, psoriasis, and dermatitis.

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Medications with the highest proportions that required PAs included biologics (55.2%) and brand-name-only therapies (42.8%). The pharmacy intervention was associated with a shorter time to PA submission (4 days vs 1 day; P <.001), shorter time to receive and record decision of PA (6 days vs 1 day; P <.001), and higher rate of PA approval (63.9% vs 80.6%; P <.001).

Compared with patients who were denied PAs, patients with approved PAs had a greater improvement in disease (58.0% vs 71.1%, respectively; P =.013). In addition, a greater proportion of patients who did not receive their original medication for which a PA was submitted experienced worsening or no change in their disease vs patients who did receive their original therapy (48.8% vs 28.4%, respectively; P <.001).

Limitations of the study included the retrospective design as well as the inclusion of only data collected from a single academic center.

On the basis of their findings, the investigators suggest that the “PA paradigm requires further action to ameliorate these current problems and improve healthcare delivery.”

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Popatia S, Flood KS, Golbari NM, et al. Examining the prior authorization process, patient outcomes, and the impact of a pharmacy intervention: A single-center review [published online May 16, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.05.024