Dee Anna Glaser, MD: I think that’s really a nice segue, as we’ve just talked about all of these treatments, to really get a better handle on how debilitating this disease can be and figure out what we need to do to help educate our patients on what’s available, as well as their parents, their loved ones, our coworkers, and our physicians. How do you guys educate? What do you think needs to be done? Where do we need to go?
Adelaide Hebert, MD: I think we do need to have more educational programs. You’ve run a session at the American Academy of Dermatology for a number of years. It’s been exceedingly well attended. But I think we have to get the word out in an even greater effort, so that our colleagues in dermatology and colleagues throughout medicine really become aware of this condition and embrace the opportunities to treat it, which I think are about to unfold.
Dee Anna Glaser, MD: Yes. What can we do to better educate physicians? Then I’ll ask Andy about insurance.
Adam Friedman, MD, FAAD: Well, in part, we’re doing it right here. The fact that we’re here is contributing to that mission. I think we need to also think about how people digest information nowadays, different demographics and how they do it. Looking at the spectrum of who hyperhidrosis affects, starting very early, we need to be targeting younger individuals. How do they get information? They get it from social media: Twitter, Instagram, Facebook. So, creating useful, practical information that is distributed in that manner is very important. I think it’s been mentioned multiple times. Sweathelp.org is not just a lifesaver for patients, it’s been a lifesaver for me, too. It makes my job easier when providing someone with that information. It will take some of the burden off your lap to provide that simple website, because a lot of the information is stuff that you would spend possibly 30 minutes to an hour going over. So, utilizing the resources, knowing about them, but also making it appropriate for the different demographics, which I think we’re starting to do but I think we need a little bit more of it, and then also engaging the media right way. And getting it out there, first and foremost—this is a medical problem. If everyone gets that, we’ve already won a big battle. And then there’s all of the other stuff that goes along with it.
Dee Anna Glaser, MD: Does anything need to be done on the payer’s side? What do we need to do better?
Andy Szczotka, PharmD: I think Adam hit it right on the head, in terms of elevating our education. We weren’t educated on this at all. This is a new disease for us. Helping the education process through multiple formats is very important. And I think reintroducing the patient to us is very important. I had the opportunity to meet a hyperhidrosis patient once. As common courtesy, I extended my hand out to shake the patient’s hand. This patient did a fist bump. That led me to saying, “Why didn’t you shake my hand?” I realized, “Now what does this relate to in your normal life?” So, I think reintroducing the patient to us is one of the most important things we can do through this process.
Dee Anna Glaser, MD: That’s helpful. I guess some of this all drives down to cost, right? So, the cost of treatment, the cost of no treatment. How do you approach that? What are some of those costs that you think about?
Adam Friedman, MD, FAAD: Cost is a very loaded term when it comes to hyperhidrosis. Depending on what treatment you’re talking about, some are very cost-effective and some are not. Even with insurance coverage, we mentioned that botulinum toxin could be quite expensive because there’s repeat dosing. But then, there’s the part that people don’t think about: the dry-cleaning costs, buying multiple shirts, avoiding certain situations, limiting your job progress, missing days of work for appointments, those co-pays. There are a lot of unseen costs that affect productivity and overall quality of life. This information needs to be disseminated throughout not only the medical community but the public. These individuals are suffering in silence, and that suffering includes a cost to their overall life.
Dee Anna Glaser, MD: Absolutely. I know from the pediatric standpoint that there’s a huge emotional component.
Adelaide Hebert, MD: It’s tremendous. In children with hyperhidrosis on the palms, who start in school, no one will hold their hand. Their safety can be compromised when they’re trying to cross the street with their classmates. They don’t want to have their hand held when they’re doing Ring Around the Rosie. It just goes on and on. Children need to hold hands in their early school years; it’s just part of safety. Yet, they’re the one person who gets ostracized very quickly. It’s really very important that they’re included in this educational piece, and for the therapeutic options, because pediatric patients really do suffer with this and that’s where the burden starts. If we can impact them, we can really make a huge difference in the lives of these patients as we go forward.
Dee Anna Glaser, MD: One of the questions I ask every pediatric patient is, “Do you ever raise your hand in class?” Consistently, the answer is, “No, I would never do that.” “Is it because you don’t know the answer?” “No, I know the answer. I just don’t want anyone to know that I’m sweating.” How does that impact their education and how the teacher feels? Are they prepared? Are they not prepared? I mean, it’s these simple things that we take for granted that really have a long-term cost for that individual in society.
Adelaide Hebert, MD: Absolutely.
Dee Anna Glaser, MD: It’s really amazing. Andy, when you’re thinking about the cost of hyperhidrosis from the payer standpoint, what are your thoughts?
Adam Friedman, MD, FAAD: Well, we kind of look at it from a multicomponent format. We typically will have the professional fees associated with people seeing the medical professionals, from the office visits and the continual care. But we also have the treatment costs, which we outlined earlier, in terms of all of the different treatment options that are available and that kind of stepwise therapy approach. And when we look at it as we’re looking at the new therapies that have been approved and the emerging therapies, those costs have kind of escalated for us from that process. So, it’s kind of coming from that perspective. But then, we also look at those secondary costs: the ancillary treatments, the anti-anxiety, potentially, and the other therapies that are involved in that process. It really is multicomponent, from both a medical and a pharmacy aspect.