Episode 131: HS Updates, Prior Auth Reform & CA Legislation in Dermatology ft. Dr. Haley Naik | The Future of Dermatology Podcast

Summary:

In this episode of the Future of Dermatology podcast, host Dr. Faranak Kamangar sits down with Dr. Haley Naik, board-certified dermatologist, professor at UCSF, and Stanford and Harvard-trained expert, for a timely and eye-opening conversation on two major fronts: the rapidly evolving treatment landscape for Hidradenitis Suppurativa (HS) and the critical California state legislation that could reshape how dermatologists practice and how patients access care.

Dr. Naik opens with exciting updates in the HS space, including the three currently FDA-approved therapies and two promising agents anticipated to cross the finish line by 2027. She also shares a major advocacy win: HS has been designated a highlighted research topic by the NIH across three institutes, opening a one-year funding window starting April 7, 2026 that researchers should act on now.

The conversation then dives deep into the broken prior authorization system, with striking data points: 25% of dermatology visits require prior auth, 75% of denial letters have no listed decision maker, and the average dermatology practice spends $40,000 per year staffing for prior authorizations. Against this backdrop, Dr. Naik breaks down three California bills - two to support and one to oppose - that directly affect how dermatologists can care for their patients.

Whether you're a dermatologist, researcher, or patient advocate, this episode is packed with actionable information, from NIH grant deadlines to how to contact your state representative before late June voting deadlines.

Learn more and take action:

AB539 (prior authorization reform): https://legiscan.com/CA/bill/AB539/2025

SB895 (California Science and Health Research Bond Act): https://lnkd.in/gTjXXxtU

Find your California representative to advocate for these bills: https://findyourrep.legislature.ca.gov/

Information about the May 4th Rally for California Science: https://www.fundcascience.org/rally

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⚠️ This podcast is for educational purposes only and does not constitute medical advice. Always consult your healthcare provider.

Key Takeaways:

1. Three FDA-Approved HS Therapies Now Available Adalimumab, Secukinumab, and Bimzelx (bimekizumab) are currently FDA-approved for Hidradenitis Suppurativa, giving clinicians meaningful treatment options that didn't exist before 2015.
2. Two More HS Therapies Expected by 2027 Povorcitinib (a JAK1 inhibitor by Incyte) and an IL-17A/F nanobody by Moonlake Therapeutics are both anticipated to receive approval in the coming years, with over 50 therapies currently in the HS pipeline.
3. NIH Has Designated HS a Highlighted Funding Topic - Act Before April 2027 HS has been named a highlighted research topic across three NIH institutes. This designation runs from April 7, 2026 through April 2027. Researchers interested in HS funding must submit applications within this one-year window.
4. The Prior Authorization System Is Widely Acknowledged as Broken Even the Blue Shield CEO publicly admitted the prior auth process is broken. The insurance industry issued a voluntary streamlining pledge in summer 2025. Key pain points include: step therapy requirements, peer-to-peer reviews often conducted by non-physicians, no identified decision maker on 75% of denial letters, and reauthorization periods as short as three months.
5. AB 539 Would Extend Prior Auth Approvals to One Full Year Currently, prior authorizations for some medications last as little as three months, forcing practices to repeatedly restart the paperwork process and creating dangerous gaps in patient care. AB 539 would require approved prior authorizations to be maintained for one year (or the full treatment course if shorter). This is especially impactful for HS patients who already face a 7–10 year diagnostic delay.
6. AB 2000 Would Ban Mid-Year Formulary Changes If a patient is doing well on a medication, insurers could currently remove that drug from formulary mid-year, forcing patients back through step therapy and increasing out-of-pocket costs. AB 2000 would prohibit these mid-year changes, protecting both patient stability and physician treatment decisions.
7. SB 1094 Would Expand Pharmacist Biosimilar Substitution Authority - and Is Opposed Under current California law, pharmacists can only substitute a biologic with an FDA-designated "interchangeable" biosimilar, which requires extensive switching data. SB 1094 would allow substitution with any biosimilar, potentially without physician notification. The California Medical Association (CMA) opposes this bill due to patient safety concerns, as it removes clinical oversight from a complex medication decision.
8. How to Take Action Before Late June Voting Deadlines California ballots are going out now. Dermatologists and patients can: (1) vote on these specific bills, and (2) call their state assembly member or representative to share their clinical perspective on AB 539, AB 2000, and SB 1094.
9. Advocacy Drives Real Change in Dermatology The NIH highlighting of HS as a funded research priority is a direct result of years of advocacy by patients and physicians through the Hidradenitis Suppurativa Foundation. Dr. Naik emphasizes that dermatologists engaging in policy and advocacy can achieve meaningful systems-level change for their patients and their practices.
10. Chronic Skin Disease Has a Broader Societal Impact Than Often Recognized Beyond the clinical burden, conditions like HS, psoriasis, and atopic dermatitis significantly affect patients' ability to work, participate in the economy, and maintain quality of life. Making this case to insurance reviewers, policymakers, and the public is part of effective dermatology advocacy.

Chapters:

00:00 – Welcome & Introduction to Dr. Haley Naik
01:26 – HS Treatment Landscape: FDA-Approved Therapies & Pipeline Drugs
03:40 – NIH Research Funding for HS: A One-Year Window Starting April 2026
05:08 – Why the Prior Authorization System Is Broken
10:07 – AB 539: Extending Prior Auth Approvals to One Year
16:58 – AB 2000: Banning Mid-Year Formulary Changes
19:51 – SB 1094: Pharmacist Biosimilar Substitution & Why CMA Opposes It
23:25 – How to Take Action & Voting Deadlines
24:14 – What's Next: The Future of HS & Dermatology Advocacy