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Submission #14 Finalized

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info Submission Details

Status: Finalized
Originally saved by: Dr Zoidberg on April 27, 2026
Finalized on: April 27, 2026 at 3:48 PM

assignment

Responses

category Patient Info

Completion Date (Auto-calculated)

De-identified Patient ID

test

Insurance Type

Commercial

Diagnosis

Psoriasis

Severity

Mild

category Visit

Visit date

2912-05-22

Was a shared decision tool used for medication selection?

Yes, SDM tool for Alopecia

How involved was the patient in the treatment decision

Topics discussed

Efficacy

Additional notes

test

category Prescription Info

Selected Medication

Bio-Etanercept (Enbrel)

Was a prescription given?

Yes

Date of Prescription

2912-05-22

Is this a new prescription or continuation of therapy

New prescription

category Workflow Milestones

Date Prior Authorization (PA) Submitted

2026-04-06

Date PA Approved

2026-04-01

Was Appeal Needed?

Yes

Date Appeal Resolved

2026-04-27

Final PA Approval Outcome

Denied

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

Insurance delay|Missing info