Prior Authorization Process May Delay Biologic Treatment, Leading to Asthma Exacerbations

senior man with wife at home coughing badly

Patients with severe asthma and urticaria who delay biologic initiation due to the prior authorization process may be at risk of disease exacerbation during the waiting period, according to a retrospective study that was published as part of the AAAAI Annual Meeting.

Following institutional review board approval, researchers at an allergy clinic reviewed 63 charts of patients with severe asthma and urticaria initiating biologic therapy between March 2014 and June 2019. They used T-test or ANOVA with Tukey post-test analysis to assess differences in continuous variables and Fisher Exact Test or Chi Squared Test for categorical variables.

The average number of days (standard deviation) from prescription submission to administration of first medication dose was 41.7 (21.5): 43.4 days (23.1 for asthma) and 35.4 days (15.2) for urticaria. Insurance approval took a mean 21.5 days (20.1), plus 20.0 days (12.0) for the medication to be filled by specialty pharmacy. Times did not largely differ regardless of diagnosis (asthma vs. urticaria), specific biologic, insurance, or clinical disease features. Patients with asthma had a high risk of requiring systemic corticosteroids during the prior authorization process, and 42% of patients (n=190) needed prednisone (average cumulative dose per person, 517 mg [267]).

“Approval processes by insurers and specialty pharmacies delay administration of biologics, during which patients are at risk of exacerbations needing systemic corticosteroids,” the researchers summarized.

https://www.jacionline.org/article/S0091-6749(19)32064-0/fulltext