The burden of insurance requirements on timely access to biologic therapy for patients with autoimmune blistering diseases: a survey of immunobullous experts in the United States

The advancement of biologic therapies has improved outcomes for patients with autoimmune blistering diseases (AIBDs). Despite medical advancements, lack of insurance coverage limits access to these medications. In this observational study, we aimed to describe the burden of prior authorizations (PAs) and insurance delays for biologic therapy in AIBD patients from the physician perspective. Surveys were completed by AIBD experts (n = 18) across the United States, amounting to a response rate of 60%. AIBD experts reported an average 3.1 week wait time for insurance approval of rituximab, with over half reporting that insurance required a change in dosing protocol. Though experts identified a benefit of dupilumab and omalizumab in bullous pemphigoid, expectant insurance denial limited the use of these therapies. Experts spent an average of 1.4 h per week on insurance-related matters for AIBD patients, and half hired additional staff in the last 3 years due to PAs for biologic therapy in AIBD patients. These findings highlight the substantial burden of insurance coverage on the utility of biologic therapy in AIBD and underscore the significant work contributions required by physicians and staff for insurance-related processes.