New Paper on Prescription Treatment Barriers for Eczema Patients

While there have been advances in atopic dermatitis (AD) treatment options, including new medications, many patients still face challenges in obtaining these treatments, even when they’ve been prescribed by their doctor. A new study from the National Eczema Association (NEA) research team examines barriers that AD patients and their caregivers face when accessing prescription treatments. Results from the study were published in the journal Dermatology and Therapy in June 2024.

“Several studies have looked at the effects of insurance-related delays and denials from the perspective of physicians and their office staff. With this study, we wanted to better understand the AD patient experience,” said Wendy Smith Begolka, co-author of the study and chief strategy officer at NEA.

To determine the frequency and causes of insurance coverage delays for AD prescriptions, the NEA research team surveyed 978 participants; 82% were adults with AD and 18% were caregivers of children with AD.

In one year, these 978 survey respondents collectively experienced 645 insurer-related prescription delays or denials, with 48% of respondents experiencing at least one such delay or denial.

Key findings

• Prescription coverage denials were caused primarily by step therapy (28%). Step therapy policies require patients to try less expensive options before “stepping up” to more costly drugs. Unfortunately, this trial-and-error approach can prolong the time it takes for patients to obtain medications that have been deemed appropriate or necessary by their physicians.

• The majority of delays were caused by prior authorization requirements (55%). Prior authorization policies stipulate that healthcare providers get advance approval from insurers before treatments will be covered. This takes time and can present logistical roadblocks.

• Coverage issues occurred across all prescription types. Patients reported facing delays and denials for steroids and other topical therapies, oral medications, as well as biologics. The highest rate was for biologics, with 44% of prescriptions either delayed or denied by insurers in the past year.

• Wait times tended to be longer for biologics and other higher-cost drugs. In many cases, wait times were longer than current guidelines recommend.

• Only 56% of respondents said they would know what to do if they faced an issue getting a prescription covered by their insurer.

What this data means for the eczema community

The data from this NEA paper shows that eczema patients frequently experience issues obtaining the therapies prescribed by their doctors. It also shows that there’s often insufficient understanding about how to address insurer issues when they come up.

“Based on this new research, NEA is taking steps to work with insurers to share our findings on the impact of delays and denials on patient care and outcomes, to advocate for mutually beneficial policies and to make step therapy and prior authorization more transparent and easier to navigate for patients,” said Smith Begolka.

In the meantime, it’s important for patients and caregivers to know what to do if faced with insurance coverage issues. A crucial first step is to talk to your healthcare provider as soon as possible after a delay or denial to help limit wait times for medication coverage.

Find additional tips for working with your health insurance company here.