Jeffrey D. Dunn, PharmD, MBA: This has been an awesome discussion. Before we conclude, I’d like to ask 1 final question and get final thoughts from each of you. As you’re sharing your final thoughts, can you address 1 specific question? What do you think is going to change in the vitiligo treatment landscape in the next 5 years? Maybe we can go in reverse order and start with Dr Epstein. Please give your final comments and what you think is going to change in the next 5 years.

David Epstein, MD, MBA: It’s going to be an area where we’re going to see more entrants into the space because the pharmaceutical industry is always doing their research. It’s going to happen, so I’m relying on the reliable, accurate, impartial, unbiased data to help us answer the questions.

I had a wonderful grandfather who was my life mentor. He was an immigrant from Russia who wound up in Chicago and worked his way up and became successful. His message to me growing up was, “Do the right thing and make a buck at it.” This is my message to the pharmaceutical industry. Up until now, pricing has been totally arbitrary and based on thinking, “What’s every last dollar I can get out of this?” The pharmaceutical industry needs to understand that they aren’t the whole pie. Coming from Chicago, I’d say that they think they’re the deep-dish pie. They need to understand that they aren’t the whole pie and they shouldn’t be driving all of the expense in health care. I’m pleading for the pharmaceutical industry to move to a more rational and fiscally responsible positioning going forward.

Jeffrey D. Dunn, PharmD, MBA: Thank you. Dr Rosmarin?

David Rosmarin, MD: I agree with Dr Epstein that I expect new entrants in the marketplace in the next 5 years, starting with ruxolitinib cream, followed by oral JAK inhibitors, and then by some more novel mechanisms. There’s going to be some work to do to decide how these different treatments fit into the paradigm. We don’t know that yet, but it’s important to be data driven and follow that pathway so we can make the best decisions for patients. It involves some shared decision-making not only between provider and patient, but hopefully there will be seats at the table between all stakeholders when payers make the decisions on how to set these treatments up in their step therapy guidelines.

Brett King, MD, PhD: It’s uncommon for Dr Rosmarin and I to be able to communicate with folks like Dr Epstein. I’m heartened by this conversation, because one of the issues is that I go to the clinic every day, and I send off an e-prescription or I fill out a PA [prior authorization] and it gets faxed. It’s all very mechanical and robotic, and there’s never a human interaction, so it ends up feeling like we’re being beaten up. We’re trying to make patients better and nobody is listening. We don’t talk to a human. Talking to a human is virtually impossible. When we do, we’re often told, “I’m the wrong human, you need to be talking to a different human.” For me, this is an amazing opportunity.

Vitiligo is going to advance. That’s certain. Our ability to translate scientific discovery into treatments that benefit humans is happening at an unprecedented rate, which is amazing, but we need to have these kinds of conversations and much bigger conversations for that to happen in a real way to benefit human health. I appreciate the opportunity.

Jeffrey D. Dunn, PharmD, MBA: I’ll build on that and chime in from my perspective. These 2 drugs will change the lens or priority of this disease state, for right or wrong. New drugs commonly advance or improve outcomes, but oftentimes at a significant cost. It’s important to get the different stakeholders at the table and talk about different perspectives, align incentives, and talk about who the appropriate patient is, what the appropriate price is, and maybe sharing risk. If we don’t do this, the cliff we’re heading toward is the affordability cliff. It doesn’t matter what we do if patients can’t afford these medications, so we have to figure this out.

This conversation has been amazing. I’d like to thank Dr Rosmarin, Dr King, and Dr Epstein for their participation in this program. I’d also like to thank our viewing audience. We hope you found this AJMC® Peer Exchange to be useful and informative. Thank you again.

Transcript edited for clarity.