News|Articles|September 23, 2026

Getting to the dermatologist is only half the battle for biologic patients

Fact checked by: Peter Wehrwein, Managing Editor

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Key Takeaways

Global dermatologist distribution and training shortfalls persist across 158 countries, even as skin disease contributes heavily to disability and is deprioritized by governments in most jurisdictions.
In the US, high dermatologic disease burden and spending coexist with limited specialist availability, with >60% of counties lacking dermatologists and prolonged waits, especially rurally.
Prior authorization workload in dermatology is substantial, with frequent denials and step-therapy requirements reframing prescriptions as provisional, delaying optimal treatments and increasing administrative expense.
Low Medicaid participation among dermatologists further constrains access for publicly insured patients, compounding geographic maldistribution and appointment backlogs.
AI can worsen coverage barriers via automated denials yet improve access through triage tools that reduce unnecessary referrals and meaningfully shorten wait times.

A recent study revealed that dermatology remains one of the most underserved areas of care and it is impacting both payers and patients.

Whether you are a payer, provider, or patient, both receiving and bestowing specialized care can be a challenge. And when patients have issues getting the care they need, it deeply impacts not just their health but all the systems that surround it. This has proven to be especially true in the dermatology. In an assessment of dermatologic care access, published in JAMA Dermatology, the Global Access to Skin Health Observatory Study (SkinObservatory) in August 2026 — a collaboration between the International League of Dermatological Societies (ILDS) and L'Oréal Dermatological Beauty — examines the distribution of dermatologists and barriers to accessing dermatological care, training, and specialist services across 158 countries, representing 97% of the world's population. The researchers note that more than 2 billion people worldwide live with skin disease, among the top ten leading causes of disability, yet 74% of countries do not treat skin health as a national government priority.

The dermatological status of the U.S.

In the U.S., skin cancer is the most common form of cancer, according to the CDC. According to the institution, a Medical Expenditure Panel Survey determined that roughly 6.1 million adults are treated annually for basal cell and squamous cell carcinomas, at $8.9 billion in costs.

According to the American Academy of Dermatology (AAD), about 1 in 5 Americans will develop skin cancer in their lifetime; roughly 9,500 people are diagnosed daily. The AAD also noted that other conditions, like the roughly 7.5 million adults with psoriasis and 16.5 million adults with atopic dermatitis, all impact Americans with various levels of severity.

And yet the access study revealed that more than 60% of U.S. counties have no dermatologist at all, and there are just 3.4 dermatologists per 100,000 people nationally. Of those, only 10% practice in rural areas, and the average wait time to see one is roughly 32.3 days, up 46% since 2009. The wait can stretch to 6–8 weeks or more in rural areas, with some patients traveling more than 200 miles.

How the lack of access can impact payers and patients

[Global for this section: Need attribution for many of these statements, methinks. Otherwise, written in an expert’s this-is-so voice. If they are coming from a particular study in AJMC, at least give date or better yet, the first or corresponding author.]

Once patients do get in, dermatology practices spend about 13 hours a week on prior authorizations and see roughly a third of them denied outright, according Jane M. Grant-Kels, MD, FAAD, professor and vice chair of the Department of Dermatology at UConn Health who spoke to the American Journal of Managed Care. Some of this can be attributed to AI-driven insurer reviews, which have driven denial rates up "16-fold." In truth, a physician's prescription is treated as a preliminary request, which means that in order for the prescription to be granted, step therapy guidelines require patients to fail on older or lower-cost medications first.

That burdens patients, who don't get the medications they actually need, and offices, given the expense of dealing with prior authorizations that tend to lead only to coverage rejections.

On top of that, only a third of dermatologists participate in Medicaid, limiting patient access, Grant-Kels noted.

For conditions like psoriasis, the combined delay — months to get seen, then a coin-flip on the biologic request — can be linked to prolonged disability, more disease flares, and delayed return to work. That means access and coverage policy aren't separate problems; they're sequential filters on the same patient.

On the flip side, AI is also being utilized to help close some of these gaps. It has helped reduce unnecessary referrals by 53% and cut wait times nearly in half.

Network adequacy standards and telehealth/AI-triage investment are how a payer addresses the first bottleneck — whether patients can reach a dermatologist quickly enough to get diagnosed and prescribed in the first place. That's the lever most directly under a plan's control on the access side. Prior authorization reform, or at minimum auditing how AI-driven review is generating denial patterns, is the lever for the second bottleneck — once a patient has a legitimate biologic prescription in hand, whether the plan's own utilization management process is the thing standing between them and treatment. Fix only one, and the delay doesn't disappear, it just moves.