Multimodal treatment, multiple perspectives, make cost-effectiveness in acne treatment a difficult puzzle to solve, says John S. Barbieri, M.D., MBA | AAD 2026

There are many different treatment options for acne, an abundance that benefits patients but presents challenges when identifying the cost-effective treatment.

“We often need to combine treatments with different mechanisms of action, because any single treatment often is insufficient to help our patients reach their goals,” notes John S. Barbieri, M.D.,MBA, director of the Advanced Acne Therapeutics Clinic at Harvard-affiliated Brigham and Women’s Hospital in Boston and an associate professor of dermatology at Harvard Medical School.

Barbieri spoke yesterday afternoon about cost-effective acne treatment at the 2026 American Academy of Dermatology Annual Meeting in Denver. He spoke with Managed Healthcare Executive (MHE) in an interview before the meeting.

With multimodal therapy, Barbieri says that clinicians need to think about which drug in each class might have the highest value — he referenced the four topical retinoids as an example — but also how to combine them efficiently. Further complicating matters is that many acne treatments have multiple active ingredients.

“We have products that sometimes have multiple [ingredients] in them that can really help, both in terms of reducing overall costs, because you don’t have to go out and buy three things; you can buy one. And also because we know when you have a fixed combination product, you get better adherence and better outcomes than when you have things being done separately,” Barbieri says

Cabtreo, which the FDA approved in 2023, contains adapalene, a topical retinoid; benzoyl peroxide, an antiseptic; and clindamycin, a topical antibiotic.

“This is the most effective single topical product we've ever had for acne,” says Barbieri. But there are treatments that combine just two active ingredients, such as adapalene and benzoyl peroxide, he notes.

“Two things in one works better than either alone,” says Barbieri. “You can get that out of pocket for about $30 if you're using the right kind of pharmacy, like Mark Cuban Cost Plus Drugs or other pharmacies like that. So it’s very affordable, very effective. Sometimes there can be some issues with irritation and tolerability, but that can often be a very good starting place for many people with acne. And you can then build upon that by adding something like a topical antibiotic, like clindamycin, that's very inexpensive as well.”

Patient assistance programs can bring down the cost of Cabtreo for patients, Barbieri observes, so it “ends up being pretty affordable, and sometimes more affordable than getting a bunch of separate products.” He notes that Cabtreo is made with an “optimized vehicle” that helps reduce skin irritation and improve tolerability.

Barbieri makes that general observation that that there is an eye-of-the-beholder aspect to cost effectiveness.

“We have the perspective of the payers or the health systems. That's going to be just what treatment costs the most, the dollars per amount of benefit it gives. Then we also have the patient perspective. Sometimes a treatment that might cost a lot of dollars might actually be less expensive to the patient, depending on certain copay assistance programs or other things,” he says.