Two years to diagnosis: Prusi discusses closing gaps in pulmonary fibrosis care | AMCP Nexus 2026

Patients with fibrosing interstitial lung diseases (ILDs), such as idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF), wait an average of about two years from their first symptoms to a diagnosis, according to Rachael Prusi, Pharm.D., MSGH, director of clinical specialty solutions at Prime Therapeutics.

Prusi co-presented a session on managing these diseases in managed care at AMCP Nexus 2026 this week with Timothy Clifford, Pharm.D., a clinical pharmacist in the pulmonary specialty clinic at UK HealthCare. In this interview with Managed Healthcare Executive, she explains why these patients are often missed and why many still go untreated after they are diagnosed.

A disease that looks like something else

These diseases cause scarring in the lungs that gets worse over time. Early symptoms can look like chronic obstructive pulmonary disease (COPD) or heart disease, which Prusi said can send patients “down the wrong diagnostic pathway.” Some providers may also be less familiar with the disease.

The right diagnosis may not come until a patient has a flare and ends up in the hospital. In other cases, symptoms finally become severe enough to prompt a referral to a lung specialist or a high-resolution CT scan, which Prusi called the cornerstone test for these diseases.

She said health plans and providers can start with education. She also suggested building prompts into electronic health records so clinicians consider these diseases earlier when patients report symptoms.

Getting patients on treatment

A diagnosis does not always lead to treatment. Prusi said some providers are not comfortable prescribing antifibrotic drugs. Some patients also choose to wait and see because they do not feel very sick yet.

That wait can cost patients lung function they will not get back.

“Time is lung,” Prusi said. “So the sooner we can start antifibrotics, the more of their lung function we can preserve, and the more we can slow their decline.”

Generics could widen access

Cost has also been a barrier. Prusi noted that two of the three antifibrotics now on the market are available as generics, which she said “could really increase the access and the affordability for a vast majority of patients.”