GW Prior Certification Coordinator Offers Tips at ElderDerm

There are no shortcuts to getting dermatologic treatments authorized by Medicaid and insurance companies, George Washington University Department of Dermatology’s prior certification coordinator said at the ElderDerm 2025 Conference in Washington, DC.

Effort and diligence are the keys when working with third-party payers, Heather Sawrey said during a panel discussion alongside Woodberry Associates partner and senior vice president Gavin Clingham. Conference co-director and PracticalDermatology editorial board member Adam Friedman, MD, FAAD, moderated.

“Be a voice,” Sawrey said. “Education is key as well. Patients have to learn to advocate for themselves, and I am the worst  person to say that because I hate when patients have to get involved with anything because it stresses them out, and if they get stressed out then they are going to flare up, [but] just education is big, and helping the patients understand that we’ll try to make sure we’ll get this covered.”

One tip Sawrey offered to clinicians in terms of what they can do themselves is to provide the proper measurables.

“One of the biggest things, without having to go through the whole song and dance, is body surface area, whether we are talking about psoriasis or atopic derm; if we are talking about alopecia then the SALT score,” Sawrey said. “[SALT] is newer and it is a little bit harder to remember. But even if you put, ‘Patient has 90% hair loss,’ that does not equate to SALT 90 for insurance companies. Like, an IGA 3 would equate to moderate. They just do not do that. It is crazy … but we do have to do that song and dance with the insurance companies. Body surface area, everything they have tried and failed, and why they may be—hopefully—contraindicated to systemic therapy.”

Being as specific as possible about failures with topical steroids is important, she added.

“Put how long they were on that topical steroid,” she said. “I’m not telling you what to do, but preferably 4 to 6 weeks, at least.”

One positive development, Sawrey said, is that many of the newer biologics and small-molecule drugs include all of their enrollment forms in one place.

“Especially with Tremfaya, they have everything under one roof now—one phone call to one person,” she said. “It’s so good; everybody should follow suit with that.”