Dr Jason Ezra Hawkes on Prior Authorization, Clinical Documentation Issues Limiting Atopic Dermatitis Treatment Access

Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of dermatology at the University of California Davis in Sacramento, discussed how prior authorizations and other insurance requirements are limiting treatment access in atopic dermatitis and how dermatologists can help ameliorate these approval issues.

Clinical documentation is vital to address prior authorizations and other insurance requirements, such as step therapy, that can delay care and lead to worse outcomes among patients with atopic dermatitis (AD), said Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of dermatology at the University of California Davis in Sacramento.


Can you speak on the issue of delayed treatment in AD, particularly the impact of prior authorizations and other barriers to treatment caused by insurance requirements in the management of patients?

The impact of prior authorizations, insurance requirements, it's really not a unique problem to dermatology or even AD, but it's gotten a lot worse. So, we're seeing more roadblocks and barriers to care. Step therapy, in my opinion, is an insurance strategy to really delay care for using specific medications, which I think is a strategy to lower costs for insurance providers, but sometimes that's at the expense of safety.

A good example, again, we've got these targeted biologics, which are highly effective, very safe, but insurers are requiring patients to go through methotrexate, cyclosporine—these are off-label therapies, and they can have significant side effects. So, this is a problem. We're seeing legislation work against these step therapy requirements so that we can get patients more quickly to more effective therapies.

I think cost is a barrier that we need to be sensitive to. And we also need to be aware of the programs that are available for patients—co-pay programs, patient assistance programs. I think the pharmaceutical industry has been very generous in these programs that try to help our patients who don't have insurance plans that make these treatments affordable.

But I think there's also a burden on physicians, it's not out of our control entirely. And I say that in part because our documentation and our clinical notes are absolutely critical. It might be even the vast majority of the battle to get certain therapies approved. I see many patients who are sent for second or third opinions who couldn't get approved for medications. Writing a detailed note with prior therapies, the duration of therapy, side effects, contraindications to other therapies, we can often get medications approved.

So, we also have to do our part by making strong cases in our clinical documentation. And that's been challenging as health care systems have pushed us to see more patients at shorter intervals. So, the documentation I think has dropped off, gotten a little poorer over time, which is working against us in trying to get the prior authorization approval that we want for certain therapies.

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