Prescription coverage barriers persist for atopic dermatitis patients despite an expanding treatment landscape: findings from a 2025 national survey

PURPOSE: Atopic dermatitis (AD) treatment has expanded considerably in recent years, yet insurance barriers such as prior authorization (PA) and step therapy continue to delay care. MATERIALS AND METHODS: We conducted a 2025 (July-September) national survey through the National Eczema Association to assess prescription coverage delays and denials among insured US adults (18+) with AD and caregivers of pediatric patients (age 0-17). RESULTS: Among 543 respondents (60.6% with moderate-to-severe disease), 37.9% experienced at least one coverage delay or denial in the preceding 12 months. Rates were higher among those who had changed insurance (51.1%) versus those with stable coverage (33.1%). Coverage barriers were most common for targeted systemic therapies, though most affected prescriptions were non-biologic. PA was the leading barrier (56.8%), often resolving well beyond recommended timeframes, and step therapy affected 34.4% of those with issues, including forced re-failure of previously failed medications after insurance changes. Nearly one-third of respondents were unaware of their appeal rights. Coverage barriers led 15.7% to never initiate and 12.4% to discontinue prescribed treatment, often resulting in untreated disease. CONCLUSIONS: Despite an expanding therapeutic landscape, prescription access barriers for AD remain pervasive, underscoring the need for policy reform and improved patient education on appeal rights.