Study reveals frequent insurance denials for pediatric biologic allergy treatments

When a child's severe asthma, eczema, hives, or food allergy isn't under control, an allergist may prescribe a newer type of medicine called a biologic. But a new study being presented at the American College of Allergy, Asthma and Immunology (ACAAI) 2026 Annual Scientific Meeting finds that getting insurance to pay for these medicines can take weeks, and many requests are turned down.

Biologics are medicines, usually given as shots, that target the part of the immune system that causes allergic disease. They can help children whose symptoms don't get better with other treatments. Before insurance will pay for a biologic, a doctor's office usually must get prior authorization – requesting permission from the insurance company to order the medication.

Researchers at a children's hospital looked at 326 prescriptions for biologic medicines written by allergists from 2018 to 2026. The children were about 11 years old on average.

The study found:

• Almost every prescription needed permission from insurance. More than 9 out of 10 required prior authorization.
• About 4 in 10 requests were denied.
• Denials happened for two main reasons. The insurance company said the child did not meet its rules, or it wanted the child to try a different medicine first. Each reason accounted for about 1 in 4 denials.
• Approval took time. On average, it took more than a month to go from the doctor writing the prescription to insurance approving it. Some families waited much longer.

When a child's asthma or allergies are out of control, every week counts. 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."

Aarti Pandya, MD, allergist, co-author of the study and ACAAI member

The researchers say the findings show the need for changes to the prior authorization process, so children can get the medicines their doctors prescribe without long waits.

"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."