Chronic Itch Often Overlooked as New Treatments Face Coverage Hurdles

In this second part of a video series, editors of Managed Healthcare Executive spoke with Shawn Kwatra, M.D., professor and chair of dermatology at the University of Maryland School of Medicine, about challenges in treating chronic itch and how managed care policies may be limiting patient access to innovative therapies.

Kwatra shared that chronic itch, often overlooked, can severely impact quality of life.

“We did a study recently about the overall quality of life of chronic itch patients compared to other systemic conditions, and it actually came out that having chronic itch can be just as severe or more severe than even having a stroke or chronic heart failure or type two diabetes,” he said.

The condition is not just uncomfortable, he noted; it affects sleep, increases inflammation and elevates risk for cardiovascular events.

With concerns about how managed care practices, particularly prior authorization and step therapy, may delay or block access to newer, more effective medications, Kwatra said that these barriers are real.

He described a common scenario where patients with severe atopic dermatitis must first try and fail multiple topical treatments, all while having widespread symptoms, before insurers will approve systemic therapies.

He said this process can mean weeks or months of continued suffering.

The discussion also touched on how the lack of FDA-approved treatments for many itch-related conditions complicates insurance coverage.

While some diseases, such as atopic dermatitis, now have approved therapies, others, such as chronic pruritus, do not.

However, patients with these conditions often respond well to the same biologic treatments.

Kwatra noted that it’s not practical to do a separate clinical trial for every type of itch, as itch is so common and shows up in many ways.

He suggested that the future lies in precision medicine, including the use of biomarkers to classify itch phenotypes across different diseases.

This approach could help regulators and payers recognize similarities across conditions, Kwatra said.

He expressed optimism that advances in diagnostics and policy reform will bridge the gap between innovation and patient access.