INTRODUCTION
Prior Authorizations (PAs) are a mechanism used by insurance companies to manage coverage of prescribed procedures, services, and medications. Studies have demonstrated that PAs are a burden for providers and reduce access to dermatology medications for patients.2,3 Specific patient groups such as those with Medicaid may experience significant delays or fail to receive prescribed medications due to delays in the PA process and/or frequent changes in Medicaid formularies. Additionally, patients with complex medical conditions are particularly at risk for delays as specialty medications such as biologics often require a PA.
Overall, there was a higher average rate of PA approvals within our centralized specialty pharmacy compared to previous
Previous studies have shown that a centralized pharmacy decreases delays in treatment.2,5 A centralized pharmacy was shown to decrease the time to PA submission to insurance companies, decrease the time to PA decision to pharmacy, and increase approval rates.4 We retrospectively examined the approval rates and timeliness of PAs at a single academic dermatology center’s centralized pharmacy in Pennsylvania between August 2021 to February 2022. PA data including insurance type, medication prescribed, date PA request received by the pharmacy, date PA was submitted by pharmacy, date PA response received by the pharmacy, and PA outcome were analyzed.
We identified 2215 PAs submitted to the centralized pharmacy between August 2021 to February 2022. Of those PAs submitted to insurance companies, 68.3% (n=1512) were ‘approved’, 18.0% (n=398) were ‘denied’, 3.4% (n=76) were ‘not covered’, and 9.0% (n=199) were ‘not required’. Systemic dermatology medications represented the majority of the PA requests. Medications with the highest number of PAs included dupilumab (n=462), risankizumab (n=201), Retin-A (n=156), adalimumab (n=132), and guselkumab (n=101). The average time from which a PA request was received from the provider by the pharmacy and a PA was submitted to the insurance company was 0.25 days. The average time from a PA submission to response from the insurance company was 1.59 days. Medicaid patients represented the majority of PA requests (Table 1).
Overall, there was a higher average rate of PA approvals within our centralized specialty pharmacy compared to previous
