Insurance Denied Your Atopic Dermatitis Prescription? What to Do Next

It’s an all-too-familiar scenario: You and your doctor think you need a prescription for atopic dermatitis, but your health insurance company thinks differently.

Remember: Just because your claim was denied once doesn’t mean it’ll be denied a second time. There are ways to build a case for yourself that will increase your odds of success.

Insurance rejections can happen for a few reasons, so the best way to find out why the prescription was denied is to call your insurance company and ask directly.

• Prior authorization, where a practitioner has to get advance approval from an insurance company before a specific treatment will be covered. To do that, your doctor needs to submit detailed documentation to make the case for why you need that treatment.
• Step therapy, where you’re required to try and “fail” other, less expensive drugs before your insurance company will cover the medication your doctor prescribed.

Medications can get denied for other reasons, too. For one, the drug your doctor prescribed may not be on your insurance plan’s list of covered medications. That’s often the case for more expensive treatments, such as biologics, says Hannah Skirrow, lead advocate for the healthcare advocacy platform Solace Health.

You may also be denied if the eczema medication is prescribed by a primary care doctor instead of a dermatologist — even if the prior authorization has been approved and you’ve met all of the step therapy requirements, Skirrow says.

Rejections can also come down to simple paperwork errors. “Sloppy or incomplete prior authorizations cause a huge chunk of first-round denials, and patients pay for a mistake they never made,” says Matt Toresco, founder of Archo Advocacy and Elavay.

Though rejections are often par for the course, especially when it comes to eczema medication, there are things you can do to increase the odds of a first-time approval.

Keep a running list of the medications you’ve tried already. “Write down the medication name, dose, how long it was used, whether it was effective, and the [healthcare] provider who prescribed it,” Skirrow says. Your dermatologist’s office can help you keep track of your medication history and confirm the information is accurate.

Whenever a medication fails, your healthcare provider should document the lack of improvement in symptoms. If you can include photos, that’s even better, Toresco says. “Then make sure your dermatologist’s office puts all of that failure history into the prior authorization with the right diagnosis codes.”

“Many times, it’s for a simple reason, such as missing documentation showing that other medications were tried and failed or the provider forgetting to include the official diagnosis with the prescription,” says Skirrow.

If all of your appeal options have been exhausted and the medication is still denied, pharmaceutical company patient assistant programs can help you avoid paying the full cost of treatment out of pocket.

“If applying for one of these programs, it is important to keep documentation of the insurance denial and any appeal attempts, as this information is often required as part of the application process,” says Skirrow.