Half of Insured Patients With AD Go Without Related Prescriptions

Diagnosed atopic dermatitis (AD) affected about 6.9 million insured people in the US in 2023, but roughly half of them filled no AD-related prescription, and dermatology advanced practice providers (APPs) delivered a large share of specialty care, especially in rural areas, according to a new report from the National Eczema Association (NEA).¹

The report, The State of AD 2026 National Indicator Report, includes an analysis by Milliman that was commissioned by NEA. It is part of a 4-year, CDC-funded initiative to produce the first comprehensive national- and state-level estimates of AD diagnosis and care across all ages and major insurance types. Milliman drew on commercial, Medicare fee-for-service, and Medicaid claims and encounter data, along with provider registry data, and extrapolated Medicare Advantage figures from the fee-for-service data. The estimates exclude about 26.8 million uninsured people and roughly 5.2 million covered by other programs, such as the Indian Health Service, Veterans Affairs, and TRICARE.

Diagnosed AD affected about 2.3% of the insured population. Unadjusted prevalence was highest in Medicare fee-for-service (3.0%), followed by Medicaid (2.2%) and commercial coverage (2.1%). The report's authors cautioned that these differences are not direct measures of disease risk and likely reflect how often AD care is sought, recognized, documented, and treated in each market, along with demographic differences. Claims-based counts typically run lower than survey-based estimates, which the report attributes in part to underdiagnosis of milder disease.

“It has gaps, just like every data set does, but it's still the most comprehensive view available, and it does give us an understanding of a shared starting point, which has not been provided before,” Kristin C. Belleson, president and CEO of NEA, said in an interview with The American Journal of Managed Care^®. “We do hope that it will open up conversations with payers and insurers and physicians and policy makers.”

Roughly Half of Patients Filled No AD-Related Prescription

Before adjusting for age and sex, 47% of commercially insured patients and 54% of those in Medicare fee-for-service and Medicaid filled at least 1 AD-related prescription in 2023 (49%-59% after adjustment). Unadjusted, topical corticosteroids were the most common therapy across markets and age groups, filled by 42% to 52% of patients.

The report notes that the prescription figures do not capture over-the-counter treatments such as low-potency hydrocortisone and emollients, so the share of patients receiving some form of treatment is likely higher, particularly among children.

Belleson said the findings point to a need for public education, because people with milder disease may not recognize it as AD.

“People don't realize it unless they see a physician, so they may think they're just dealing with sensitive skin, or something that is a little bit more minor than atopic dermatitis,” she said, adding that they may manage symptoms with over-the-counter products or self-care.

Systemic Corticosteroids Often Exceed Dupilumab Use

Before adjustment, systemic corticosteroids were used by 4% to 5% of patients with diagnosed AD, often more than dupilumab (2%-4%; Dupixent; Regeneron and Sanofi), the most commonly used guideline-based systemic therapy. Guidelines recommend against systemic corticosteroids for AD because of rebound flares and adverse effects with prolonged use.² Oral Janus kinase inhibitors and conventional immunosuppressants were each used by fewer than 1% of patients.

The authors noted that some systemic corticosteroid use may be misclassified as AD-related because the drugs have other clinical uses. They also wrote that AD severity cannot be reliably determined from claims data, so it is not possible to say whether systemic therapy use overall is appropriate.

Belleson said the finding did not surprise NEA. “I don't think we're surprised. I think it's possibly what we anticipated, just given different individuals' access to care,” she said.

On topical corticosteroids, she added that it is important for patients to understand how to use them appropriately.

APPs Deliver Up to 37% of Dermatology Visits; Telehealth Use Is Low

Dermatologists and dermatology APPs, such as physician assistants and nurse practitioners, accounted for a minority of all-cause office visits among patients with diagnosed AD but about 42% to 60% of AD-related visits, after adjusting for age and sex. APPs alone delivered 26% to 37% of all-cause dermatology office visits compared with about 10% to 12% of primary care visits, and the pattern held when the analysis was limited to AD-related visits.

In rural areas, APPs accounted for roughly 10 to 12 percentage points more dermatology visits than in urban settings. The authors said this highlights APPs' contributions in places that typically have more limited physician specialty supply.

The national average was about 7.5 dermatology and allergy/immunology practitioners per 100,000 people, but density differed by more than 3-fold across states and the District of Columbia, from 15.2 in DC and 13.6 in Massachusetts to 4.4 in Oklahoma. Registry data likely undercount APPs, particularly those in multispecialty groups, so these counts probably understate APP supply.

Telehealth played a limited role, accounting for 2.8% to 3.6% of AD-related office visits after adjusting for age and sex. Use was lowest in dermatology (1.2% to 1.3% of visits) compared with 5.0% to 5.5% in primary care.

Given how much care flows through APPs and primary care clinicians, Belleson said NEA sees an opportunity to change how it engages providers.

“The biggest opportunity is to really reach out to primary care physicians [PCPs] and work with PCPs in a way that we have not before,” she said, noting that PCPs may have a basic understanding of AD but not the full breadth of the chronic condition.

Comorbidities, Acute Care, and Children

About 10% to 15% of patients with diagnosed AD, or roughly 783,000 people, also had asthma, and 8% to 15%, or about 703,000, had skin infections. AD-related emergency department or observation visits affected 1.2% to 4.6% of patients, and urgent care visits affected 2.5% to 5.2%. Fewer than 1% had an AD-related inpatient admission.

Belleson said NEA hopes to work with payers to understand the comorbidities that can come with undiagnosed AD, and how earlier education might help minimize urgent care and emergency visits.

Children had higher diagnosed prevalence than adults in both the commercial and Medicaid markets. Among children aged 0 to 2 years, prevalence was 10.4% in the commercial market and 8.0% in Medicaid. Children were generally less likely than adults to fill AD-related prescriptions and were more likely to receive lower-potency topical corticosteroids. Belleson attributed some of the higher pediatric diagnosis rate to parents who, when an infant can't speak up, “do whatever they can” to make sure the child is comfortable, along with more frequent pediatric and primary care visits early in life.

Belleson said policy-makers and payers should understand that access is only part of the picture.

“AD can be controlled and it can be treated,” she said, adding that the first comprehensive national and state-level estimates will help NEA target places where AD is more prevalent and educate people “perhaps in a different way than we've done previously.”

Reference
1. Hansen D, Bazell C, Pelizzari P, McPherson R. The State of Atopic Dermatitis in the United States. Milliman; August 2026. Commissioned by the National Eczema Association. Accessed October 1, 2026. https://stateofad.org/state-of-ad-report/

2. Chu DK, Schneider L, Asiniwasis RN, et al. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol. 2024;132(3):274-312. doi:10.1016/j.anai.2023.11.009