Study Finds Insurers Denied 4 in 10 Requests for Children's Biologic Medicines
A review of 326 prescriptions at one pediatric center found frequent prior-authorization denials and an average wait of more than a month for approval.
Insurance companies denied nearly four in 10 prior-authorization requests for children's biologic medicines in a study released Thursday by the American College of Allergy, Asthma and Immunology.
Researchers reviewed 326 prescriptions written by allergists at a single tertiary pediatric center from 2018 through 2026. The medicines were prescribed for allergic conditions including severe asthma, eczema, chronic hives and food allergy. The patients' median age was 11.4 years.
The study found that 93.6% of prescriptions required prior authorization, meaning the insurer had to agree to cover the medicine before it could be obtained. Among those prescriptions, 39.3% were denied.
The most common reasons for denial were failure to meet the insurer's criteria, accounting for 24.4% of denials, and a requirement to try another medicine first, accounting for 23.4%. The average time from prescription to approval was 32.65 days.
Biologics target parts of the immune system involved in allergic disease. The review included omalizumab, dupilumab, mepolizumab, benralizumab and tezepelumab. Omalizumab accounted for more than half of the prescriptions reviewed.
Co-author Dr. Aarti Pandya said delays can leave children waiting weeks for treatment their allergists believe they need. The researchers called for changes to the prior-authorization process. The findings come from a retrospective review at one center, rather than a national survey, and are being presented at ACAAI's annual meeting in Phoenix.