Coverage and policy
An evidence base for HS coverage decisions.
The joint AAD and HS Foundation guidelines give 37 recommendations, each with its strength and the certainty of the evidence behind it, reported separately. This page is the payer view of that, plus what the guidelines say about coverage practice in their own words.
In the guidelines’ own words
On step therapy
“Step therapy, an insurance requirement that patients complete a sequence of insurer-designated treatments before coverage is approved for a physician-prescribed therapy, lacks evidence of clinical benefit and is associated with treatment delays, reduced access to guideline-concordant care, and worse clinical outcomes.”
On cost
“Notably, effective treatments may reduce long-term economic burdens for payers and the healthcare system and direct costs of HS therapies should be weighed against indirect costs of uncontrolled disease, including wound care, lost productivity, and disability assistance.”
Short-term savings, long-term costs
While payer and healthcare system tools to manage healthcare utilization and drug expenditures, including step therapy and prior authorization, are effective at reducing short-term therapeutic costs, they are also associated with treatment delays, reduced adherence, and worse clinical outcomes that can drive higher long-term costs. These effects compound existing barriers to HS care, including diagnostic delay averaging 7 to 10 years and limited access to specialty dermatology.
Every therapy, with both ratings
Strength of recommendation and certainty of evidence are reported separately. The payer view puts both in one table, with the conditional recommendations that rest on low-certainty evidence shown alongside the strong ones.
| Therapy | Class | Population | Strength | Certainty |
|---|---|---|---|---|
| Adalimumab | TNF inhibitor | Moderate to severe HS | Strong | Moderate |
| Bimekizumab | IL-17A/F inhibitor | Moderate to severe HS | Strong | Moderate |
| Infliximab | TNF inhibitor | Moderate to severe HS | Strong | Low |
| Secukinumab | IL-17A inhibitor | Moderate to severe HS | Strong | Moderate |
References for coverage teams
One page each, built for a policy file rather than an exam room.
What the guidelines say about coverage criteria
Step therapy, severity documentation, and the evidence base
Where to go next
Talk to the HS Foundation
For questions about the guidelines, coverage policy, or working with us on access.
The full guidelines
Published in the Journal of the American Academy of Dermatology.