Prior auth · March 3, 2026
Biologic and JAK Inhibitor Prior Authorization Is Tightening
Prior authorization does not usually deny revenue outright. It delays it, and in a biologics practice a delay is functionally the same thing because the patient does not start therapy and the visit does not happen.
What plans are asking for now
- Documented step therapy: which conventional agents were tried, for how long, and why they failed or were contraindicated.
- Objective severity measures at baseline, such as affected body surface area, and in many cases photographs.
- Shorter re-authorization windows, so an approval obtained in January may need renewal well before the patient's next scheduled visit.
- Site-of-care rules for infused agents, which can redirect administration away from the practice entirely.
Running authorization as a queue, not a task
The practices that lose least treat authorization as a tracked worklist with dates, not as paperwork attached to a visit. Every active biologic patient has a known expiry date, and renewal work starts a fixed number of days before it. Renewals started after expiry are the single largest cause of therapy gaps we see.
The second habit that matters is capturing the step-therapy history once, in a structured place, so it does not have to be reconstructed from years of notes at every renewal.
Frequently asked questions
Can we bill for the time spent on authorizations?
Generally not as a separate service. The return comes from avoided delays and avoided denials, which is why the work belongs on a tracked queue with owners and dates rather than squeezed between patients.