What stands in the way of patients with atopic dermatitis getting prescription medication? Here are some possibilities

Atopic dermatitis is one of the most common skin conditions in the U.S., with an increasing number of choices on how to treat the condition. But research findings scheduled to be presented at the fall meeting of the Academy of Managed Care Pharmacy (AMCP) this week in San Diego suggest that standing between patients and those choices are a variety of financial, geographic and insurance-related obstacles.

Two abstracts slated for presentation at the meeting, which is called AMCP Nexus, pointed to managed care practices, such as prior authorization and formulary placement, as barriers. Research summarized in another abstract identified access problems in rural areas. Another abstract based on a focus-group-like program organized by the AMCP called AMCP Market Insights pointed to limited access to dermatologists.

Allison Loiselle, Ph.D., associate director of data science and research at the National Eczema Foundation, and her colleagues are based on findings from a survey of 533 adults with atopic dermatitis or the caregivers of children with the disease that was conducted from July to October last year. The survey was designed to examine their experiences with access to prescription drug treatment in the previous 12 months. Among the 364 respondents who had the same health insurance for 12 months or more, almost a third (119) had experienced at least one prescription delay or denial, and prior authorization was most frequently identified as the barrier, according to Loiselle and her co-authors. Of the 39 prior authorizations denials that the respondents said were eventually approved, 17 (just over 40%) took more than five weeks to resolve.

Rural vs. urban prescription patterns

Loiselle is also the lead author of an abstract about research into urban and rural differences in prescriptions for atopic dermatitis that was funded by the Centers for Disease Control and Prevention. Using a U.S. administrative claims database, prescription fill rates per 1,000 members with diagnosed atopic dermatitis. They found that fill rates for topical Janus kinase inhibitors were 50% lower among rural members than urban members (13.4 per 1,000 vs. 26.9 per 1,000). The fill rate for topical calcineurin inhibitors was also considerably lower (35%) among the rural members (73.1 per 1,000 vs. 98.6 per 1,000). The pattern was just the opposite for systemic corticosteroids with a prescription fill rate of 70.6 per 1,000 members in rural areas compared with 57.0 per 1,000 members in urban areas.“Commercially insured individuals in rural areas showed lower utilization of newer nonsteroidal AD [atopic dermatitis] therapies and high reliance on SCS [systemic corticosteroids] compared to their urban counterparts,” wrote Loiselle and her co-authors, who were individuals affiliated with academic medical centers. Loiselle and her colleagues stopped at identifying the rural-urban differences, without diving into the reasons for them. They said that understanding the reasons for the disparity — formulary differences and prescriber availability were mentioned as possibilities — could inform policy and payer strategies.

Formulary placement of biosimilars

Rachel Day, M.D., chief medical officer at Zest Health, a tele-dermatology company, and her colleagues trained their sights on formulary design as a possible barrier to access to biosimilars, particularly to biosimilars to Humira (adalimumab), which the FDA has approved as treatment for plaque psoriasis and hidradenitis suppurativa, in addition to its indications for rheumatoid arthritis, Crohn’s disease, and several other conditions. Tapping into a CMS database on Part D plan formularies, Day and her colleagues found biosimilars to Humira had no tier advantage over biosimilars, despite biosimilars having been on the market for three years. They noted the contrast to biosimilars to Stelara (ustekinumab), which had a two-tier advantage over their brand-name reference product.

“Realizing the full savings potential of biosimilars in dermatology will require pairing formulary design with prescriber-level incentives, network stewardship, and value-based contracts that drive use of high-value alternatives,” wrote Day and her colleagues.

Denise Wolff, Pharm.D., and her colleagues reported on an AMCP Market Insights program that convened eight stakeholders in the management of moderate-to-severe atopic dermatitis. Half of the group identified teledermatology as the most effective strategy to improve equitable access.