What Criteria Identify a CRSwNP Patient as a Biologic Candidate?

In an interview with Pharmacy Times, Timothy Clifford, PharmD, associate adjunct professor of pharmacy and surgery at the University of Kentucky College of Pharmacy, discussed treatment decision-making for chronic rhinosinusitis with nasal polyps (CRSwNP), covered at the Immunology Day of Education 2026, held June 10. He explained that biologic candidacy is largely driven by a patient's quality of life and ongoing symptom burden, including the need for repeated steroid bursts or increased hospital and clinic visits despite standard therapy. Clifford noted that with multiple biologics now targeting the type 2 inflammatory pathway, shared decision-making is guided by factors such as patient age, comorbid conditions like asthma or other allergies, and prior treatment failures. He also emphasized that thorough chart documentation and familiarity with regional insurers' prior authorization requirements are key strategies pharmacists can use to prevent delays or denials in biologic therapy.

Pharmacy Times: Can you please introduce yourself?

Timothy Clifford, PharmD: Hi, I'm Tim Clifford. I am a clinical pharmacist at the University of Kentucky, and I'm also on adjunct faculty at the UK College of Pharmacy as well.

Pharmacy Times: When evaluating a CRSwNP patient who hasn't responded to standard therapies, what criteria do you lean on most heavily to determine they're a candidate for biologic intervention—and how do you factor in the risks of ongoing corticosteroid use in that conversation?

Clifford: I think, really and truthfully, it's their quality of life and their symptoms. So, if patients are still having issues despite having therapy, and then really they're needing additional medications—if they're required to have more steroid bursts, they're in the hospital more often, they're in the clinic more often—those are things I really kind of look at from that standpoint of, like, if it's not optimized, this is what we're going to look at. They're still having trouble, so then it's like, if they're still having problems, a biologic is really something that we can kind of think of at that point.

Pharmacy Times: Several biologics are now approved for CRSwNP, each targeting different points in the type 2 inflammatory pathway. How do you guide shared decision-making when more than one agent could be appropriate for a patient?

Clifford: Well, part of it may depend upon the age of the patient and other comorbid conditions. So, if they also have asthma, along with nasal polyps and chronic sinusitis, that's something that we're going to kind of look at. If they also have maybe other allergies going on, other comorbid conditions are really going to help us drive that therapy and figure out what that is. Now, if they failed other therapies before, then it's kind of easier—okay, you failed this one; let's try something that's a little bit different from that standpoint as well.

Pharmacy Times: Prior authorization and coverage barriers can significantly delay care for these patients—what are the most effective strategies pharmacists can use to navigate those processes and keep biologic therapy on track?

Clifford: I think a couple of things: we can actually make sure that the documentation within the chart is appropriate for what we need to get those prior authorizations, so incomplete documentation can delay therapy or can get a prior authorization denied as well. Pharmacists working in specific areas—you will get to know the insurance companies that are common in your area, so you may actually start to understand what those pieces are that the insurance company is going to ask for. Therefore, you can actually have that documented and in the chart and ready to go to help facilitate that going forward as well.