543 Evaluating the burden of prior authorization in the treatment of psoriasis

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(PAs) compared to other medical specialties and even primary care practices. A recent survey study revealed an increasing number of PAs being required over the past year, and the negative effects on patients include delaying or preventing proper treatment. This is especially problematic for psoriasis patients. Psoriasis affects over 7.4 million people in the United States, and many remain untreated or undertreated. We conducted a retrospective review of all dermatology visits in an academic practice from May 1, 2017 to July 31, 2017 to investigate the PA burden in psoriasis and other dermatologic conditions. Of all prescriptions written during this time period (n=4862), psoriasis prescriptions had a higher requirement for PA as compared to non-psoriasis prescriptions (14.0% vs. 8.9%, p=0.001). Of psoriasis PAs, 32% were for biologic agents. Time to process PAs from the time of initiation to time of decision was similar for psoriasis versus non-psoriasis prescriptions (8.4 days vs. 8.8 days, p=0.8). The denial rate for psoriasis PAs was higher but not statistically different as compared to non-psoriasis PAs (30% vs. 25%, p=0.363). The most common psoriasis prescriptions that required PA were clobetasol, adalimumab, tacrolimus, and apremilast. The most common reasons for PA denial were step therapy required or non-formulary medication. Our study shows that prescriptions written for psoriasis require PAs at a higher rate than other dermatologic conditions. The increased requirement for PAs for psoriasis may contribute to psoriasis undertreatment and is likely partially due to the availability and high cost of biologic agents. With further development of biologic agents for psoriasis and other dermatologic conditions, the PA burden for dermatology will likely continue to increase. Further studies are needed both to evaluate processes that streamline PAs and to examine the impact of the burden of dermatology PAs on patient treatment outcomes and administrative healthcare costs.