Dermatology practices are absorbing a growing share of the cost of prior authorization, as payer-required reviews continue to expand across the specialty's most commonly prescribed therapies, according to a new AJMC report.

The finding lands at a moment when dermatologists already rank among the physicians most burdened by authorization requirements. Therapies that anchor modern dermatologic care — systemic agents for psoriasis and atopic dermatitis, biologics, isotretinoin, and topical prescriptions for chronic inflammatory disease — routinely trigger payer review before dispensing. Each requirement converts clinical time into paperwork and forces practices to decide whether to staff for it, delay care through appeals, or write off the expense.

What the AJMC analysis makes explicit is where those costs settle. Payers design prior authorization to control utilization and spending. But the administrative work of justifying treatment — chart review, documentation assembly, phone and portal exchanges with insurers, resubmission after denials — does not bill to any code. The practice absorbs it, and the report characterizes that absorbed burden as rising.

The mechanism is familiar to anyone running a dermatology clinic. A physician recommends a biologic for a patient with moderate-to-severe plaque psoriasis. The prescription enters a payer's review queue. Staff compile documentation of prior therapies, disease severity, and treatment failure. The insurer may approve, deny, or request more information. Each cycle adds days to weeks of delay for the patient and hours of unbilled labor for the practice. Multiply that across a high-volume medical dermatology schedule and the arithmetic becomes structural rather than incidental.

The report's framing also carries a signal for payers and policymakers. When authorization costs shift onto practices, two failure modes follow. Smaller practices, lacking dedicated prior-authorization staff, may narrow the therapies they prescribe toward agents with lighter review requirements — a form of therapeutic selection driven by paperwork rather than clinical judgment. And patients face treatment delays that, in inflammatory dermatoses, translate directly into weeks of uncontrolled disease.

For dermatology specifically, the stakes concentrate in chronic conditions where therapy is longitudinal. Psoriasis, atopic dermatitis, and chronic spontaneous urticaria patients refill continuously; each refill cycle can reopen the authorization question depending on plan design. Practices that manage large biologic panels therefore carry a repeating administrative load, not a one-time per-patient cost.

The industry response to date has been fragmented. Electronic prior authorization promises to shorten cycle times, and interoperability standards continue to develop, but adoption varies by payer and by practice-management system. Dermatology groups have also invested in dedicated authorization staff and standardized documentation templates — internal fixes that reduce friction but do not change the underlying economics: the payer imposes the requirement, and the practice pays to satisfy it.

Regulatory attention is following the trend rather than leading it. State-level prior authorization reform continues to advance across legislatures, typically setting decision timelines and limiting retroactive denials. Whether those measures reduce the absorbed cost burden for specialty practices, as opposed to shortening patient wait times alone, remains the open question the AJMC report raises.

Practice leaders reading the report will likely recognize the pattern in their own revenue-cycle data. The actionable next step is quantification: measuring staff hours per authorization, approval turnaround by payer, and denial-reversal rates converts an anecdotal frustration into a negotiable operational metric. As payer review requirements continue to expand across dermatologic therapeutics, practices that measure and document the absorbed cost will be better positioned to argue for streamlined pathways — and to demonstrate, with their own numbers, what authorization requirements actually cost the delivery system.