Strategies for Improving Patient Access to Dermatology Care

This content was produced independently by The American Journal of Managed Care^® (AJMC^®) and is not endorsed by the American Academy of Dermatology.

Elizabeth Jones, MD, FAAD, dermatologist at Thomas Jefferson University Hospitals, addresses the common issue of insurance companies preferring newer, expensive medications over equally effective and safe generics. She highlights the frequent need for prior authorizations in dermatology, with staff often dedicated to navigating the appeal process. To streamline this, the American Academy of Dermatology (AAD) provides an online appeal letter tool.

Jones advocates for patient partnerships, suggesting resources like GoodRx.com to find potential cost-effective alternatives. She also points to specialized pharmacies that manage prior authorizations and utilize coupon codes, sometimes even offering personalized delivery. Although these solutions benefit patients in the short term, she emphasizes the need for systemic improvements to the prior authorization process itself.

This transcript was lightly edited for clarity; captions were auto-generated.

Transcript

How do you handle situations where a patient's insurance prefers a newer, more expensive medication, even when an older generic is equally effective and safe?

We run into this situation all the time. It still surprises us often, sometimes when you submit something, and it comes into play a lot with topical medicine. Sometimes for psoriasis, you'll try to get something called tacrolimus, and they'll come back and say, "no, we want you to try calcipotriene."

For rosacea, we might try to get the metronidazole gel, which is a pretty classic medication, or cream, and they'll come back and say, "no, we want you to try azelaic acid." In these scenarios, you can do a number of things. One, the classic response is to file an appeal if you truly think that your choice is the best fit for that patient. We are very good in the field of dermatology at navigating that appeal system, because 25% to 30% of all of our medications need a prior authorization.

We often have to have a staff who is specifically trained to help us write up these letters, which are very onerous, time consuming. It requires putting in data to help support your argument. The AAD has done a wonderful job of creating a tool. They have this online tool, it's an appeal letter tool. A lot of other specialists and societies can sort of replicate this tool for their physicians who struggle with the same thing. It's one of the most used tools on the AAD website. It is vetted by dermatologists, who are experts, new medications are added to this tool in general. There's many medications that we can use it for, so that's a very effective and powerful way of trying to make this whole system of writing those appeals more efficient.

A lot of institutions have specialty pharmacies. For example, I'm hospital based, so we have a specialty pharmacy that helps us write up these letters as well. Sometimes you have to circumvent the system entirely, so you just say to the patient, look, I'm going to advocate for you, we're going to be spending time trying to work with your insurance, writing up these letters, working through any denials. This is a time-consuming process and I think it's really important to try to partner with your patients, so you can ask them, "Can you please go online?" There are different websites, for example, GoodRx.com; they can plug in their zip code, they can plug in the medication that we want, and they can see even out of pocket, what that cost would be. Sometimes it's even cheaper than what they would pay through insurance coverage or after insurance coverage. We are becoming more and more savvy with this as we have to continue to navigate this issue.

There are even pharmacies who have created businesses out of this whole issue. There's an apothecary in the state where I work at, in Delaware, where they only do dermatology medications. They help process the prior authorization, and then they apply coupon codes they find from the website, and then they call the patient and actually deliver it to their house within, usually 1 to 2 day turnaround.

During the holidays, they even wrap the medication in extra cheerful wrapping. The patients are very satisfied with these types of pharmacies. It does come into question, is this the right way to go about it? Who is really the winner there? How are those cost savings being used? Certainly, if it benefits the patient, it seems like a good thing, but I think it's not getting at the issue that the whole process needs to be improved.