Dermatology Prior Authorization Services

Dermatology prior authorization services play a crucial role for both dermatologists and their patients. In the US, the medical cost is huge and failure to obtain prior auth can lead to claim denials and out-of-pocket expenses for your patients.

As a dermatologist, you have been dealing with various skin, hair, and finger-related issues like acne, psoriasis, dermatitis, hair issues, fungal infections, etc. And your practice may involve common areas like- topical medications, systemic medications, dermatohistopathology, immunotherapy, phototherapy, laser therapy and surgery which can be quite an expensive process and so this is where practices struggle with prior authorization; as the objective of a pre-auth is to ensure the right selection of drugs with right price and is made and patient safety.

While taking patient care is your priority, you cannot ignore a critical responsibility like prior authorization.

Approximately, 30% of the global population suffers from dermatologic issues. The demand for dermatologic medication has been skyrocketing as the population ages and skin cancer rates increase. Biologics for skin cancer and psoriasis are the key reason behind the huge demand and prices for dermatologic medications. This is exactly where dermatology prior authorization services play a crucial role by keeping the costs in check. Prior authorization is a utilization process that requires healthcare providers to obtain approval from payers before prescribing costly medications like biologics. Unfortunately, obtaining PA is not as easy as it sounds.

Challenges with Prior Authorization for Dermatology Practices-

• Continued usage of the inefficient and age-old fax-based systems of PA processes and communication often results in approval delay
• To meet the requirements of the PA cycle, dermatologists use on-formulary medications that are outdated, ineffective, and sometimes even medically inappropriate for patients
• Lack of a designated contact person from a payer’s side to discuss the exact reasons for prior auth denials
• Complexities in obtaining approvals to use non-FDA drugs for pediatric patients
• The shortage of an experienced administrative team that can efficiently manage the increasing volume of prior auth requirement
• Different payers have different guidelines for the same medical procedure or treatment, resulting in confusion among dermatology practices