Prior authorization assistance

Discover tools to generate prior authorization appeal letters for patients, a hotline to talk to Academy experts, and resources to help navigate prior authorization and drug pricing issues

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Tab 1

Prior authorization requires providers to obtain advance approval before performing a service to qualify for payment coverage. Prior authorization for medications usually involve brand-name products for which there is no generic equivalent, or a drug that a patient has taken for years but for which the insurance carrier now requires annual re-authorization.

Most physicians consider prior authorization to be an expensive and time-consuming process that questions their clinical judgment and siphons resources away from patient care. Even more concerning are the treatment delays and negative patient health outcomes that can be caused by prior authorization.


Common prior authorization drugs
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The table above shows which drugs AAD survey respondents felt most commonly had prior authorization requirements.

In early 2016 the Academy sent surveys to a total of 208 AAD members and 500 Association of Dermatology Administrators & Managers (ADAM) members. Survey recipients were requested to forward the survey to those responsible for completing prior authorizations in their practices. A total of 72 AAD members and another 106 members of ADAM completed the survey.

  • Most respondents claim to process six or more prior authorizations daily.
  • The responsibility of processing prior authorizations largely falls on clinical staff; however, dermatologists share more of this role in solo and non-group practices.
  • Not being listed on a formulary, or being listed on a higher tier, are key reasons for prior authorizations with some also citing step therapy and cost as reasons.
  • Prior authorizations are typically processed via fax or telephone, with a sizable proportion also being processed online.
  • Biologics typically take longer to process for staff, compared to non-biologics, regardless of processing method.
  • The majority agree that they have seen an increase in the number of drugs requiring prior authorization and the subsequent delays in patient treatment.

 

pre_auth_hotline_icon.pngNeed help? Call the Academy's practice support line. Speak one-on-one with an Academy expert who will help you navigate your practice issues. Complimentary for a limited time. Call 866-503-SKIN, option 1.

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Tab 2

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Generate prior authorization appeal letters

Create a customizable clinically specific letter for the top drugs used in dermatology. Create an appeal letter! 

Dermatologic diseases in the tool          Drugs in the tool
   

Acne vulgaris
Actinic keratoses
Atopic dermatitis
Primary focal hyperhidrosis
Psoriasis vulgaris
Rosacea
Tinea unguium
Urticaria


       

Aczone
Botox
Class 1 Steroid
Class 2 Steroid
Corticosteroid spray or foam
Cosentyx
Doryx
Dupixent
Elidel
Enbrel
Epiduo
Eucrisa
Finacea Foam
Humira
Isotretinoin
Jublia







  Kerydin
Mirvaso
Otezla
Picato
Protopic
Remicade
Rhofade
Siliq
Solodyn
Soolantra
Stelara
Taltz
Tazorac
Tretinoin
Xolair

pre_auth_hotline_icon.pngNeed help? Call the Academy's practice support line. Speak one-on-one with an Academy expert who will help you navigate your practice issues. Complimentary for a limited time. Call 866-503-SKIN, option 1.

Tab 3

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Step therapy action

Have you experienced step therapy, and has it delayed you from accessing a necessary treatment? If so, then the AAD wants to hear from you. 

Submit your story

step-therapy-map-cropped.jpgThe AAD state policy team actively advocates for states to enact step therapy laws. As of 2016, the following 10 states have step therapy laws enacted: California, Connecticut, Indiana, Kentucky, Louisiana, Maryland, Missouri, Mississippi, Washington, and West Virginia.

Each legislative session several states consider step therapy legislation and the state policy team needs your help to ensure the states adopt these bills. By writing about your own personal experience with step therapy and sending it to the AAD, it will help us advocate for your respective state to enact step therapy legislation.


Prior authorization action

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In response to the increasing burden of prior authorization, several state legislatures passed laws to address this issue. The AAD supports the American Medical Association (AMA) model state legislation for prior authorizations.

If your state legislature is considering a prior authorization bill or you are interested in having your state introduce a bill, contact the AADA state policy team.

pre_auth_hotline_icon.pngNeed help? Call the Academy's practice support line. Speak one-on-one with an Academy expert who will help you navigate your practice issues. Complimentary for a limited time. Call 866-503-SKIN, option 1.

Tab 4

B-Resources.jpgTips and tools


Prior authorization contacts for insurers​

(Note: It is always recommended to refer to the phone number on the insurance card. The numbers listed below are subject to change.)


Products to help process prior authorizations faster

Learn about free electronic prior authorization products that can aid your practice in processing prior authorizations in a quicker, more efficient manner.


Related resources


Related articles

pre_auth_hotline_icon.pngNeed help? Call the Academy's practice support line. Speak one-on-one with an Academy expert who will help you navigate your practice issues. Complimentary for a limited time. Call 866-503-SKIN, option 1.

Tab 5

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How do you overcome difficulties in carrying out treatment plans due to insurance?

Dermatology World recently asked AAD members to discuss their challenges related to insurance and prior authorization.
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“I calculated last year that it took 5,280 hours just to get prior authorizations for mostly biologics. So I make sure that I know the major payers in my area, and I’ll ask the drug reps to find out what the step algorithms are for those payers. Then if I know I have to use phototherapy and methotrexate before I can get a biologic, I won’t bother writing for the biologic first if I can’t get it. That’s really one of the only defenses you have, and you have to really bug the reps to get you that kind of information. I also do a PGA (physician global assessment) and a body surface area for all my patients so I can document their extent of disease at any time point, so if an insurer asks if it’s working, I can actually prove it.”

Alice Gottlieb, MD, PhD, assistant professor of dermatology at New York Medical College, Valhalla, N.Y.

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Make sure the patient is an active participant. Have them check in with their insurance company and your office on a regular weekly basis to keep the process moving forward. Forewarned is forearmed, as they say. I always try to make sure the patient understands at their visit that there may be cost or insurance challenges and that we will work with them to overcome the barriers. Handouts for patients from the AAD can be helpful to prepare patients. We keep a log of all patients prescribed biologics or similar medications, then check the log weekly to make sure each patient is on track, or make the appropriate calls if the process has stalled.”

Colby Evans, MD, chair of the National Psoriasis Foundation board of directors, Austin, Texas

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“Just today we heard that we no longer have a Highmark provider services representative. Meaning when we run into a brick wall, we no longer have access to an advocate who can help us find the right person to speak with. That’s the trend. Insurers now use benefit managers with strict protocols, and generally there are no exceptions. I always used to spend extra time dogging insurers until I got what the patient needed. Now — with rising costs, exponentially increasing demands on nonexistent time, and declining reimbursements — I’m about to join the ranks of those who say, I’m sorry, there’s nothing more I can do for you.’”

Lisa Pawelski, MD, Pittsburgh

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“I think a lot of it has to do with preparing the patient for the fight that we have to go through together. It’s also important to educate your nursing staff on the fundamental science of why certain medicines are needed and why they need to argue for them. Once a patient had a drug that was really necessary declined by the insurance company, and I actually called and spoke with their medical officer to try to understand what his reasoning was, and what his requirements were that needed to be documented. Like, my patient is suffering, what’s it going to take? He actually gave me bullet points, and the phraseology that I needed to use, so I adapted. A lot of my colleagues feel they shouldn’t have to do that, but that kind of thinking doesn’t serve us well. It’s unfortunate that we have this fight, but we have no choice but to learn about the process and to be effective at it. It’s like any Darwinian situation. We have to adapt so that our patients survive.”

Shadi Kourosh, MD, director of community health at Massachusetts General Hospital, instructor in dermatology at Harvard Medical School

pre_auth_hotline_icon.pngNeed help? Call the Academy's practice support line. Speak one-on-one with an Academy expert who will help you navigate your practice issues. Complimentary for a limited time. Call 866-503-SKIN, option 1.

Tab 6

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Need help? Call the Academy's practice support line

Speak one-on-one with an Academy expert who will help you navigate your practice issues. Complimentary for a limited time. Call 866-503-SKIN, option 1.


Join the Academy's Prior Authorization Community

The Academy has launched an online discussion forum that allows members to ask expert staff questions about prior authorization, drug pricing, and step therapy. AAD members also are encouraged to share their experiences with their colleagues.

join the discussion


Questions about legislation in your state?

If your state legislature is considering a prior authorization or step therapy bill or you are interested in having your state introduce a bill contact the AADA state policy team.

pre_auth_hotline_icon.pngNeed help? Call the Academy's practice support line. Speak one-on-one with an Academy expert who will help you navigate your practice issues. Complimentary for a limited time. Call 866-503-SKIN, option 1.