Challenges Across Skin Phenotypes

Maria Lopes, MD, MS, reviews some challenges surrounding access to care, patient education, and financial burdens associated with psoriasis across skin phototypes.

Ryan Haumschild, PharmD, MS, MBA: There are still challenges because not everyone has that model. A lot of these patients are still being treated in the community. Dr Lopes, what are some of the challenges surrounding access to care? What are some of the patient education or financial burdens across all skin phototypes?

Maria Lopes, MD, MS: In terms of access to care, in many communities, patients have to travel—sometimes 50 miles—to see a dermatologist or a rheumatologist. The next available appointment may not be until 3 or 4 months later. It’s incumbent upon what a best practice looks like to create awareness and to help PCPs [primary care physicians] initiate the identification, the diagnosis, and the initiation of treatment. The other is the time factor. These patients take a lot of time. Particularly in a PCP world, they’re looking at comorbidities rather than psoriasis as a condition. That’s also where the quality measures are. You’re scored based on things like diabetes, hypertension, and dyslipidemia. There’s a big overlap with psoriasis, but the focus is on the other comorbidities and not psoriasis per se.

How do we bring a more holistic and integrated approach? On the financial side, the reality of financial toxicity is growing. More specialty drugs fall into coinsurance, not co-pays but coinsurance. Some medications are excluded from the formulary because many payers don’t cover every drug in every category of every mechanism of action. Some may be covered and are preferred, but even those that are preferred may have a coinsurance. Dr [Bruce] Sherman alluded to patient out-of-pocket costs. Although the accumulators seem benevolent in the end, patients face the reality of, “What is this going to cost?” They may have started on treatment. Even though the treatment is effective, they end up going off treatment because they can’t afford it. [We need to be able] to counsel patients appropriately.

There are also co-pay maximizers, which amortize the value of that coupon over a calendar year. In essence, this creates more predictability around the patient’s out-of-pocket cost and, hopefully, fosters greater compliance. I completely agree. The integration of a care team includes a clinical pharmacist and a social worker. A lot of these patients have a lot of psycho-social issues: transportation needs, even housing sometimes. If we don’t ask, we don’t know.

It’s also about what happens between office visits. An office visit will always be very short. To be able to capture meaningful and actual information between office visits gives the clinician insight into how the patient is doing, instead of relying on the patient in that minute to tell us. They may not even remember what’s happened in the past 3 to 6 months. Some of the value of highlighting what’s important may come from technology. It helps to have greater shared decision-making but also a much more efficient process, in terms of what that dialogue looks like between the patient and the clinician, including the PCP. This highlights challenges but also opportunities to do better.

Ryan Haumschild, PharmD, MS, MBA: It does. It sounds like there are a lot of opportunities for organizations to make an impact.

Transcript edited for clarity.

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