Insurance Delays: Biologic Approvals for Patients With Psoriatic Disease

Insurance approval and the need for prior authorization can be barriers to care for patients with psoriatic disease. In the recent study “Insurance Delays in the Approval of Biologic Medications for Patients With Psoriasis and Psoriatic Arthritis,” the authors “sought to determine whether race/ethnicity, insurance type, and provider specialty affect biologic approval times” by reviewing records from a university health system. The Dermatologist met with Dr Andrea D. Maderal and Dr Thomas Vazquez, 2 of the study’s authors, to discuss their findings.

The Dermatologist: In your study, did race/ethnicity impact biologic approval times?
Dr Vazquez: We were interested in looking at race/ethnicity to see how it impacted biologic approval times for patients with psoriasis. In our data, we did not identify an obvious impact of race/ethnicity on approval times or biologics. We have a few theories as to why that might be. It may be partly because our study was underpowered to detect a small difference in biologic approval times. There are also questions about whether our sample coming from a largely affluent White Hispanic population in Miami is representative of various underrepresented groups as a whole or whether, in fact, there was not a true difference. That is something we are interested in looking into further. But on face value, we did not identify an impact of race/ethnicity on biologic approval times.

The Dermatologist: How does biologic approval diff er between insurance types?
Dr Vazquez: A lot of people assume that having private employer provided insurance implies that you have better coverage and better access to health care. But we did not necessarily find that to be the case in our study, which is something that we were quite surprised about. We found that patients with government-funded insurance plans, namely Medicaid and Medicare, waited shorter periods for their biologics to be approved than patients with private insurance. This harkens back to why we did not find that race/ ethnicity played a part in insurance approval times because it is possible underrepresented groups tend to be overrepresented in government-funded insurance plans, which are a little complicated in our case because many of the Medicaid plans in Florida are contracted out to private insurance companies but with state oversight. We did find in our study that patients with Medicare or Medicaid tended to have a greater percentage of same-day approval of their biologics or did not have to wait as long for their medication to be approved, which we believe leads to better treatment outcomes for those patients.

The Dermatologist: How can physicians and nurses advocate for their patients when dealing with prior authorizations and biologic approvals?
Dr Maderal: One important thing is always remembering to keep the patient’s best interests in mind. In addition to delaying access to therapy for our patients, prior authorization is also very cumbersome and labor intensive for dermatology practices, which has led some practices to try not to prescribe medications that require prior authorization. Other practices have fees that they are now instituting to help cover the labor necessary to proceed with these medications. Our study showed that even if it does take time, we were able to get these medications for patients through a wide range of insurance plans, including some of our federally-funded plans such as Medicaid where people may think that it would be more challenging. We should always keep in mind that even if the insurance companies are putting forth obstacles for us to be able to get patients what they need, we should do everything we can to provide them with adequate treatment. The other side of it is figuring out how best to navigate the process so prior authorizations are successfully approved each time they are submitted, such as making sure our documentation is complete and all the needed requirements are met.

The Dermatologist: Are there any tips or insights you would like to share with your dermatology colleagues regarding insurance delays in the approval of biologic medications?
Dr Maderal: Counsel patients appropriately by having them set realistic expectations of how long it is going to take for them to get the medication and encourage them not to lose hope. Just because they do not get the medication right away does not mean that they will be unable to obtain it. In our study, we saw that for several of the plans, especially the commercial plans, the wait times were more on the spectrum of about a month to obtain approval. It is important to let our patients know the time it may take for them to get their medication and update them throughout the process, so they do not become discouraged about the chances of obtaining it.

Dr Vazquez: We learned that if the insurance company does ask for a prior authorization, you can expect the wait time to be significantly longer than if no prior authorization is needed. Make sure to be mindful of whether you are providing your patient with adequate care to bridge them to that approval. Also, be mindful of whether the patient’s disease is progressing or flaring in the meantime. Calibrating your expectations for how long it may take for the patient to get the medication is a takeaway.

Reference
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