Insurers Deny 4 in 10 Pediatric Asthma Biologic Requests
A study of 326 pediatric biologic prescriptions found most required prior authorization and many were denied or delayed.
Updated on Nov. 12, 2026 in Asthma
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Insurers denied approximately 40% of insurance requests for pediatric asthma biologic therapies, according to a study of prescriptions written by allergists between 2018 and 2026. Approved prescriptions took more than one month on average to receive a coverage determination.
Why it matters
Biologic therapies often require prior authorization for uncontrolled atopic conditions such as asthma, and denials frequently stem from coverage rules or requirements to try an alternate medication first. For families and clinicians in the United States, these barriers can delay access to treatment for children with difficult-to-control asthma.
The study reviewed 326 biologic prescriptions from a single pediatric center, with omalizumab (55.8%) and dupilumab (26%) the most common; the median patient age was 11.4 years. Whether these patterns apply to other U.S. hospitals and insurers has not been established.
The players
American College of Allergy, Asthma and Immunology (ACAAI)
The ACAAI is a professional medical society of allergists and immunologists that holds an annual scientific meeting where research such as this study is presented.
The details
Researchers conducted a retrospective chart review of biologic medications prescribed by allergists at a tertiary care children's hospital in Kansas City, Missouri, covering omalizumab, mepolizumab, benralizumab, dupilumab, and tezepelumab. The study found insurers primarily denied requests because patients did not meet coverage rules or because insurers required an alternate medication to be tried first.
Timeline
Prescriptions evaluated in the study were written between 2018 and 2026.
Study findings were presented at ACAAI 2026.
Big Picture
The findings extend the documented pattern of payer prior-authorization requirements for biologic therapies, which the study notes apply across uncontrolled atopic conditions including asthma, atopic dermatitis, chronic urticaria, and IgE-mediated food allergy, into the pediatric asthma population. Denials driven by required alternate-medication trials show how step-therapy rules shape which children reach biologic treatment.
Families whose children need biologic asthma treatment may face a prior-authorization process that takes over a month and can end in denial. Knowing that denials often arise from coverage criteria or required alternate medications can help parents and clinicians prepare documentation before submitting a request.
The takeaway
Insurance prior-authorization rules can be as decisive as clinical need in determining whether a child receives a biologic asthma therapy. Parents who understand common denial reasons, such as unmet coverage criteria or step-therapy requirements, may be better positioned to address them early.
Further reading
Explore more on Asthma to see how treatment access and insurance rules affect people living with the condition.
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