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Submission #12 Finalized

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info Submission Details

Status: Finalized
Originally saved by: Dr Zoidberg on April 17, 2026
Finalized on: April 17, 2026 at 6:34 PM

assignment

Responses

category Patient Info

Completion Date (Auto-calculated)

De-identified Patient ID

6516515

Insurance Type

Medicaid

Diagnosis

Hidradenitis Suppurativa

Severity

Mild

category Visit

Visit date

2026-04-14

Was a shared decision tool used for medication selection?

If no please indicate reason for not using SDM tool

Patient was a non-English speaker

How involved was the patient in the treatment decision

Topics discussed

Efficacy|Cost

category Prescription Info

Selected Medication

Bio-Adalimumab (Humira) or biosimilar

Medication Type

Biologic

Was a prescription given?

Yes

Date of Prescription

2026-04-14

Is this a new prescription or continuation of therapy

New prescription

category Workflow Milestones

Date Prior Authorization (PA) Submitted

2026-04-17

Date PA Approved

2026-04-17

Was Appeal Needed?

Final PA Approval Outcome

Approved

category Process Timings

Time Rx to PA Submission (days) (Auto-calculated)

Time PA Submission to Approval (days) (Auto-calculated)

Time PA to First Fill (days) (Auto-calculated)

Total Time: Rx to First Fill (days) (Auto-calculated)

category Roles And Responsibility

Who Submitted PA

Physician

category Barriers Delays

Barrier to prior auth approval

Other