Prior Authorization’s Impact on Dermatologists

The Academy surveyed dermatology practices on prior authorization in 2020, breaking out those working at a solo practice, dermatology group, academic medical center, or a multi-specialty group. The findings show that prior authorizations are a significant burden.

The Academy surveyed dermatology practices in 2020. Did you know?

Dermatologists could see up to 5-8 extra patients in a day if no prior authorization was required.

About 25% of patients that come to a dermatology practice require prior authorization.

Among patients not approved for prior authorizations, 27% experience a delay or abandon treatment, with the remainder forced into step therapy or alternative treatments.

What are prior authorizations exactly?

Prior authorization is a process the patient’s insurance company may require before it will authorize coverage of certain medications or services. These services may include anything from a treatment plan to a healthcare service and more. Usually, it is the dermatology practice that must navigate prior authorization on behalf of the patient. Many procedures also require prior authorizations, led by phototherapies, patch testing, and Mohs surgery.

Why are prior authorizations such a significant burden?

Prior authorizations are an administrative burden because of the lengthy process it can take to complete a prior authorization. This process includes but is not limited to follow-up with the patient or insurer, written form and data entry, patient tracking, and appeal letters. Prior authorizations also cause a considerable increase of direct and indirect costs to cover medications and services, lengthier patient visits, and much more.

Who is responsible for doing the prior authorization?

It depends on the needs and size of the dermatology practice. It can be the dermatologist, a medical assistant, or other office staff—whoever is assigned the role in the practice. Hiring an employee dedicated to processing prior authorization can be helpful, if you have the resources. About a third of dermatologists have hired full-time staff to process prior authorizations. Another option is hiring a college intern or medical student to take the weight of prior authorizations off clinical staff in the practice.

How does the prior authorization process work?

There are several steps that go into prior authorization, and these can vary based on your practice. There is no right single way of doing prior authorizations because they also vary between insurance companies, what medication or services are being processed, whether insurance challenges the dermatologist’s preferred choice, how long the process takes, and more.

Take a look via the cards below at an example of a simple prior authorization workflow that goes through a pathway including the clinical staff, administrative staff, insurance provider, and patient. Consider questions such as:

• What happens during an initial encounter?

• What happens when generating a prior authorization?

• How is a response planned?

• What happens when a prior authorization is approved?

• What challenges can happen during the process of a prior authorization?

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