‘All of us are facing this burden’: Tips to alleviate prior authorization struggles
Key takeaways:
- To accelerate the prior authorization process, physicians could use the electronic prior authorization system and/or train more staff members.
- Successful prior authorizations require close attention to detail.
SAN DIEGO — Getting prior authorization for medications can be a struggle in allergy and asthma care, but creating templates and paying attention to detail can speed up the process and lead to more success, according to a presentation here.
“I have 120 documents in my prior authorization bin at all times,” Priya J. Bansal, MD, FAAAAI, FACAAI, allergist and immunologist at Asthma and Allergy Wellness Center in Illinois, faculty member at Northwestern Feinberg School of Medicine and consulting medical editor for Healio’s Women in Allergy, said at the 2025 American Academy of Allergy, Asthma and Immunology/World Allergy Organization Joint Congress.
“I don’t think it matters whether you’re in academics, whether you’re in a hospital-based system or you’re [in] solo practice — all of us are facing this burden right now,” Bansal added.
To aid physicians in the “elusive” world of prior authorizations, Bansal offered several tips that will help them be more efficient during this process.
In her first tip, “know the payors criterion for each of the medications you file for,” Bansal recommends creating templates for each drug, which will allow physicians to quickly fill in blanks rather than starting from scratch each time.
According to Bansal, a template for a new asthma biologic start should reference that a patient is maximized on a high dose ICS/LABA, that they have failed multiple rounds of a steroid, their ACT score and the biologic they would benefit from.
Notably, patient IgE level, eosinophil count and quality of life survey scores (Urticaria Activity Score [UAS-7] and Investigator Global Assessment [IGA]) may also need to be included when filing for biologics, Bansal said.
Bansal’s second tip is “do not submit a prior authorization you know will fail.”
To prevent this from happening, physicians should carefully read the prior authorization’s requirements, which Bansal notes may contain a treatment that the patient must fail before coverage, ahead of submitting the form.
Other tips for speeding up the prior authorization process include using the electronic prior authorization system, training several staff members and using a virtual medical assistant, according to Bansal.
Bansal further noted that successful prior authorizations will require close attention to detail.
“Make sure to have the diagnosis code correct for the item you are submit[ting],” Bansal wrote on her presentation slide. “[Additionally,] make sure insurance is up-to-date and their name matches in your system and on their insurance card.”
If a prior authorization is denied, Bansal highlighted four measures that physicians can take: peer to peer, appeal, external review and sending letters.
Knowing that prior authorizations can negatively impact allergy and asthma care by delaying it, advocacy is essential, according to Bansal.
“Push back with local and state policies and make sure the timeline is addressed for a more rapid turnaround,” Bansal wrote on her presentation slide.
Notably, Bansal highlighted that physicians can share difficulties they face with prior authorization at advocacy@AAAAI.org.
“If you are having these difficulties, others are as well,” Bansal wrote on her slide.
For more information:
Priya J. Bansal, MD, FAAAAI, FACAAI, can be reached at asthmaallergywellness@gmail.com.
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Bansal PJ. Prior authorizations: Is the burden easing? Presented at: 2025 AAAAI/WAO Joint Congress; Feb. 28-March 3, 2025; San Diego.
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