Assessing the prior authorization landscape for hidradenitis suppurativa

Summary: Abstract Body: Adalimumab, secukinumab, and bimekizumab are approved biologics for moderate to severe hidradenitis suppurativa (HS). However, patients often require off-label therapies after failing first-line treatments or experiencing adverse effects. HS care is fraught with prior authorizations (PA), insurance denials, and appeals, leading to medication delays and administrative burden for clinicians and their staff. This study assessed the administrative burden, PA turnaround times, and approval rates for on-label and off-label HS treatments at a single-center HS specialty clinic. 66 commercially-insured HS patients received biologics between 1/1/23 and 3/31/24. 44 received on-label treatments (adalimumab and secukinumab) and 22 received off-label treatments. PA turnaround times, approval rates, and patient messages were analyzed, and providers and nurses were surveyed about their experiences. The mean PA turnaround time for on-label treatments was 6 days, with a 91% approval rate, compared to 71 days and a 56% approval rate for off-label therapies. On-label medications generated an average of 8 patient messages compared to 22 for off-label medications. Survey responses revealed that 82% of staff reported spending more than half their time managing PAs. Appeal letters, peer-to-peer calls, and communication with insurers were identified as the most time-consuming tasks. This study demonstrated that off-label biologics required nearly 12 times longer for PA appeal decisions, had nearly half the medication approval rates, and generated 3 times the volume of patient messages compared to on-label biologics. Both providers and nurses felt that PAs contributed strongly to burnout among staff and patients, and comprised a substantial portion of inbasket duties. These findings highlight the administrative challenges of managing HS and suggest that private dermatology practices, with fewer resources than academic centers, may face even greater barriers in securing treatment for their patients. Andy Ho¹, Sarah Amjad¹, Sophia Penuela², Stella Chen² 1. Mayo Clinic School of Medicine - Scottsdale Campus, Scottsdale, AZ, United States. 2. Department of Dermatology, Mayo Clinic Arizona, Scottsdale, AZ, United States. Clinical Research: Epidemiology and Observational Research