Approximately 40% of insurance requests for pediatric asthma biologic therapies are denied, with approvals taking more than a month on average.


RT’s Three Key Takeaways:

  1. High Denial Rates: More than 90% of pediatric biologic prescriptions required prior authorization, and roughly 4 in 10 requests were ultimately denied by insurance providers.
  2. Treatment Delays: Families faced an average wait of more than a month between prescription submission and insurance approval, placing pediatric patients at risk for worsening symptoms and adverse healthcare outcomes.
  3. Call for Prior Authorization Reform: Study investigators called for policy changes to streamline and accelerate the insurance approval process so children can receive critical prescribed therapies without prolonged waits.


When pediatric patients experience severe, uncontrolled asthma, eczema, hives, or food allergies, allergists may prescribe biologic therapies that target specific components of the immune system responsible for allergic disease. However, securing insurance coverage for these therapies frequently involves prolonged wait times and high rejection rates, according to study findings presented at ACAAI 2026.

Researchers at a children’s hospital evaluated 326 prescriptions for biologic medications written by allergists between 2018 and 2026. The patients had an average age of approximately 11 years.

The analysis revealed that obtaining access to these therapies presented substantial administrative hurdles:

  • More than 9 out of 10 prescriptions required prior authorization from insurers before coverage would be granted.
  • Approximately 4 in 10 requests were denied.
  • Denials stemmed primarily from two factors: the insurer determined the patient did not meet specific coverage rules, or the insurer required the child to try an alternate medication first. Each rationale accounted for roughly 1 in 4 denials.
  • For prescriptions that were approved, the process took an average of more than a month from initial prescription to final coverage determination, with some families experiencing significantly longer delays.

“When a child’s asthma or allergies are out of control, every week counts,” said Aarti Pandya, MD, co-author of the study and ACAAI member. “The doctor and the family have already decided this medication is the right choice. Then they wait, sometimes for more than a month, and many times the answer is still no. Delays like these can put children at risk of serious health problems.”

The study authors emphasized that the findings highlight an urgent need for reforms to the prior authorization system to prevent administrative barriers from disrupting necessary clinical care.

“We hope this data helps start a conversation about making the approval process faster and simpler,” said Dr Pandya. “Children shouldn’t have to wait weeks for care their allergist knows they need immediately.”


Study Abstract

BIOLOGIC MEDICATION DENIALS IN PEDIATRIC ATOPIC CONDITIONS
R301
M. Holland*, M. Jacobson, C. Reinert, E. Cramer, A. Pandya, Kansas City, MO.

Introduction: Medication denials by insurance companies represent a growing barrier to timely and effective care for patients with atopic and immunologic conditions. Optimal treatment for uncontrolled atopic conditions such as asthma, atopic dermatitis, chronic urticaria, and IgE-mediated food allergy can require biologic therapy which often require prior authorization (PA) by payors. This study was performed to evaluate the landscape PA denials of biologic therapies by payors.

Methods: We conducted a retrospective chart review from a tertiary care pediatric care center of patients who had been prescribed biologic medications for atopic conditions by allergists. Medications included were omalizumab, mepolizumab, benralizumab, dupilumab and Tezepelumab that were prescribed between 2018 to 2026.

Results: A total of 326 prescriptions for biologic therapy were identified. The median age of the patients was 11.4 years old and male patients were 50.3% and female patients were 49.7%. A total of 93.6% of prescriptions required a PA. Among the biologics prescribed, more than half were for omalizumab (182; 55.8%) and the second most frequently prescribed was dupilumab (85; 26%). Of those requiring a PA, 39.3% of prescriptions were denied. The most common reasons for denial included not meeting insurance criteria (24.4%), a trial of a pre-requisite (23.4%). The mean days from prescription of medication to approval was 32.65 days.

Conclusion: This study showed a significant time delay from prescription of biologic therapy to final approval of medication. Delays in therapy can put patients at risk for serious health outcomes. This study suggests the need for policy change for the PA process for medications.