568 The impact of prior authorizations for patients with complex dermatological conditions

Abstract

The current prior authorization (PA) process poses a significant burden on physician practices, particularly in fields with a high rate of medication prescriptions such as dermatology. Such a cumbersome process may deter physicians from advocating for their patients to receive the services they need, significantly delay treatment, and inhibit patient follow-through. To enhance patient compliance, medication access, and ultimately patient care, further knowledge about the PA process for dermatological practices is needed. Past studies have explored the impact of PAs for acne and psoriasis treatments, but how patients with more complex dermatological conditions are impacted is not well understood. To characterize the problem in this patient population, administrative time spent on addressing these PAs for patients with complex dermatological conditions was assessed. For a single provider’s dermatologic practice, the start and stop time for administrative activities associated with PAs (e.g. form completion, peer-to-peer dialogue) was tracked over the course of 3 months (n=30). For each patient with a prescription requiring PA, median administrative time per patient was 30 min (IQR 17.75-72.5 min) resulting in 43% approvals and 46% initial denials (insurer’s decision still outstanding for 10%). These patients experienced significant delay to treatment; from time of prescription of medication or diagnostic test to time of receipt of treatment or diagnostic procedure, patients were delayed a median of 11 days (IQR: 6-33.5 d), in addition to unquantifiable distress associated with care and in 2 patient cases, inpatient hospitalization to receive the appropriate medication. Thus, an enhanced understanding of the impact of the PA process on patients with complex needs in both the outpatient and inpatient settings will be critical in designing better systems to streamline the process for independent physician practices and the larger U.S. healthcare system.