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Dr Robert Sidbury Discusses Payer Considerations for Dermatologists Managing Patients With Atopic Dermatitis


Robert Sidbury, MD, MPH, chief, Division of Dermatology, Seattle Children's Hospital, spoke on considerations for dermatologists in seeking payer coverage of novel, expensive therapies for atopic dermatitis.

As novel, more expensive therapies come to market in the management of atopic dermatitis, it is incumbent upon dermatologists to provide adequate documentation of disease severity and other valuable metrics in seeking coverage among payers and insurers, said Robert Sidbury, MD, MPH, chief, Division of Dermatology, Seattle Children's Hospital.


What are some future considerations for payers, dermatologists, and any other physicians managing the care of patients with atopic dermatitis?

I appreciate that question because we sort of touched on this a bit in the sense that there is really a disconnect, oftentimes, between the significance and impact of this disease. Here we're talking about patients being at greater risk for depression, for anxiety, possible increased risk of suicide—we didn't mention that before. It's not as strong an association, lower quality evidence, but obviously, an incredibly impactful, important outcome.

So, mentioning all of those comorbidities and those associations, and then you look at the flip side, and you have something that some people call just eczema. And so it's that disconnect that for payers I really love to emphasize because for the first time—we've glanced on this too—in the last few years we're having new medications come out that are fundamentally more impactful and effective than anything that we've had before.

New medicines are expensive, and if we have this perception that there are these expensive medications for just eczema, well, if that's all I know about it, I’d say that's not approved either—use your creams, use your moisturizers, it’s just eczema. But clearly it's not, and so clearly, payers need to understand that as best they can, and it's incumbent upon dermatologists to paint that picture.

How do you paint that picture? Well, speaking at the most granular level with a single individual patient in front of you who you would like to get a new medication approved, that means documenting. It means not just saying: oh, my patient has severe eczema—I want dupilumab or I want some other new, relatively expensive medication. Insurers are going to look at that and say: okay, well, that's not good enough—you need to tell me why and you need to tell me how severe.

Historically, dermatologists have not been as good at doing that in our notes, in part, because we haven't had a lot of therapeutic heterogeneity or options with which to offer our patients and so it wasn't as much of an issue—now it is, we've got these new medications, some of which are quite expensive.

So, it's incumbent upon dermatologists to say: okay, my patient has severe eczema. What do I mean by that? Well, they have an Investigator Global Assessment score of 3 or 4, either moderate or severe. They have a body surface area of 10%, 20%, whatever it is, document that.

And then document what the quality of life impact on the patient is so the insurers, the carriers, the payers can see: oh, my gosh, this patient is having trouble at work because of this? They're having psychosocial impact because of this? This child is performing poorly in school because of this? Well, sure, that sort of reframes it for me. It's not just eczema, we need to do better by this child.

So, I think all of those things are ways that the advent of these new medications sort of have changed day to day practice for dermatologists in how we treat and document our patients. It's changed the way payers have to think about patients with atopic dermatitis and most importantly, and most happily, it's improved the quality of life of our patients.

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