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The tools for formulary management for atopic dermatitis need flexibility to take into account quality-of-life issues and patient access.
The treatment landscape for atopic dermatitis, a chronic inflammatory skin condition, is rapidly expanding. This means managed care pharmacy will face several issues as pharmacists assess the impact of new therapies on patients and plans, Stephanie Cho, Pharm.D., clinical pharmacy specialist in dermatology at Kaiser Permanente in Colorado, said at the AMCP Nexus 2021 meeting in Denver.
“Managed care organizations will face the challenge of balancing therapeutic outcomes, medication safety, quality of life impact, and increasing drug costs of these new treatments,” she said. “Costs for treating topic dermatitis will increase due to the diversity of symptom presentation, safety precautions, and costs. This will drive the need for formulary management.”
But the tools for formulary management, Cho said, need flexibility to take into account quality-of-life issues and patient access and equity.
Out-of-pocket costs and indirect costs that patients face are high and are increasing. She pointed to a 2019 survey by the National Eczema Association on atopic dermatitis out-of-pocket costs. The survey found that 57.5% of patients has three or more different prescriptions, and median out-of-pocket expense was $600. But 43% of those surveyed spent more than $1,000 annually.
“What stood out for me was that 65% of respondents noted that these out-of-pocket costs were a financial burden for them,” Cho said. Additionally, the disease burden and financial disparities were higher among Black patients.
There are many aspects that effect quality of life for patients with atopic dermatitis, Clive Liu, M.D., director of psoriasis treatment center at Bellevue Dermatology, said during the same session.
“The rash itself is factor, as well as itch and pain, which are connected to sleep disturbance,” he said.
He cited a 2016 study that found that itch and pain were the most burdensome of symptoms. Of the adults in this survey with moderate-to-severe atopic dermatitis, 63% reported itch lasting at least 12 hours and 61% reported pain.
“Children with AD have a four to six times higher likelihood to sleep less than six hours. And that is also true with adults. We all know that without adequate sleep, we don’t perform nearly as well in our daily functions,” Liu said.
For children, a lack of sleep can also result in emotional and conduct problems, and the family suffers as well.
Liu said atopic dermatitis affects up to 20% of school-age children and up to 7% of adults, with rates higher among people of color.
Atopic dermatitis increases healthcare resource utilization, with more prescriptions written, more outpatient and emergency department, and more hospitalizations. Cho cited one study from 2013 that showed annual direct costs for patients with atopic dermatitis was $24,401 versus $14,619 for patients without atopic dermatitis.
Cho also discussed one of the newer treatments approved for atopic dermatitis. Approved in September 2021, Incyte’s Opzelura (ruxolitinib) cream is for the short-term treatment of mild-to-moderate atopic dermatitis in patients 12 years of age or older. It targets the JAK1/JAK2 pathway.
The therapy’s label, however, includes a warning related to possible cardiovascular risks of JAK inhibitors. “About 5% of the drug is thought to be adsorbed systematically so the label has a warning about the use of CYP 3A4 inhibitors and other biologics and immunosuppressives,” she said.