Patients With Psoriasis Prescribed Biologics Face Care Delays From Prior Authorization

A brief report found that a need for prior authorization affected biologic approval wait times for patients with psoriasis, especially those with private insurance.

Insurance type and a need for prior authorization were identified as factors that impact wait times for patients with psoriasis who are prescribed biologics for treatment, according to a new report published in Archives of Dermatological Research.

Psoriasis is thought to affect up to 11.4% of adults globally, and low socioeconomic status has been associated with a higher prevalence of severe disease. The most effective treatment for moderate to severe psoriasis includes biologics, but many patients with psoriasis and psoriatic arthritis face delays in care due to a need for insurance approval and prior authorization for biologics.

Researchers assessed biologic approval wait times using medical records from 101 biologic-naïve patients with psoriasis at the University of Miami Health System between 2000 and 2019. Main variables of interest included patient race/ethnicity, provider specialty, and insurance type.

A need for prior authorization was significantly associated with long waits for approval (P = 2.4 x 10−5) in a multilinear regression model, but race/ethnicity was not a significant factor in patient wait times in this study. Non-Hispanic White patients waited a mean of 29.7 days for insurance approval, and African American or Hispanic patients waited a mean of 27.2 days.

There were significant differences in same-day approvals depending on the type of insurance the patients had. Those with health maintenance organization (HMO) carriers received same-day approval 23.7% of the time; preferred provider organization (PPO) carriers, 11.5%; Medicare carriers, 63%; and Medicaid carriers, 40%. Mean wait times were 7.3, 11.3, 37, and 41.3 days for Medicare, Medicaid, PPO, and HMO carriers, respectively.

In the multilinear regression model, Medicaid was also predictive of approval wait time (P < .05) in addition to the need for prior authorization. Overall, patients who had private insurance waited the longest for biologic approval, regardless of whether they were PPO or HMO carriers. There was no difference in the type of biologic prescribed based on insurance type.

Study limitations included its retrospective nature, which prevented assessment of variables such as income, education level, or other aspects of socioeconomic status. The cohort was also largely White-Hispanic, limiting the study’s generalizability to a national population. The authors noted that differences in prescriber preference and certain insurance policies could also drive wait time differences, but 71% of the patients in the study cohort were prescribed either adalimumab or etanercept—both of which are usually preferred by insurance companies.

“Our results did not show a difference in insurance approval times for biologics based on race/ethnicity,” the authors concluded. “However, we found that patients with private insurance carriers had fewer same-day approvals and had to wait longer than 7 days more frequently than those with government-funded plans.”


Vazquez T, Forouzandeh M, Lin D, et al. Insurance delays in the approval of biologic medications for patients with psoriasis and psoriatic arthritis. Arch Dermatol Res. Published online November 14, 2022. doi:10.1007/s00403-022-02457-6

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