Prior Authorization Outcomes for Advanced Dermatologic Therapies in a Centralized Coordination Model: A Postimplementation Descriptive Analysis

Advanced systemic dermatologic therapies (ASDTs) have transformed dermatologic care but remain subject to prior authorization (PA) requirements that delay treatment initiation and impose administrative burdens. To address these barriers, the Mount Sinai Health System established the Biologics Treatment Center (BTC) in 2018 to centralize PA management and patient education.

Assess PA approval rates, turnaround times, and patterns across medications and therapeutic categories within the BTC.

Following Standards for Quality Improvement Reporting Excellence guidelines, we conducted a quality improvement analysis of PA requests for ASDTs managed by the BTC. Using de-identified specialty pharmacy data from Shields Health Solutions, we examined PA submissions between June 2020 and December 2021. Descriptive statistics summarized PA status and turnaround time (mean, median, and interquartile range) overall and by medication and therapeutic category.

Of 2,183 PA requests, 73.0% were initially approved, increasing to 87.3% after appeals. The median PA turnaround time was 1 day (interquartile range [IQR]: 0-3) overall. Median turnaround times were 1 day (IQR: 0-3) for approved requests, 2 days (IQR: 0-4.25) for appealed and overturned cases, 1 day (IQR: 0-4) for appealed and upheld cases, and 2 days (IQR: 0-6) for denials without appeal. Approval rates varied substantially by medication, ranging from 97.4% for adalimumab to 30.8% for tildrakizumab.

This analysis describes PA outcomes for ASDTs within a centralized coordination model, including approval rates, turnaround times, and variability across medications. These findings provide insight into operational performance and highlight areas for further investigation into factors influencing PA outcomes.