Maria Lopes, MD, MS, reviews how clinicians and payers can work together to minimize any potential treatment delays, ensuring patients receive needed care in the timeliest manner.
Ryan Haumschild, PharmD, MS, MBA: What are your thoughts? How can we work together as health care providers and payers to make sure we’re having some unique considerations for generalized pustular psoriasis [GPP]? If we are infusing that patient, how can we reduce the time to treatment to ultimately get the best care possible?
Maria Lopes, MD, MS: Again, there are 2 different scenarios; 1 is chronic, and 1 is acute flares. Some patients may not have a flare for a year or 3 years. There’s also the shelf life, how long is a drug good for? If someone is carrying that drug on the shelf and it costs $50,000, or whatever it is, I think, so we have to work out the details here. One of the best practices I’ve seen is once a diagnosis is confirmed and severity is confirmed, and certainly, if you’ve been hospitalized, you’re probably much more severe, you want to avoid another hospitalization. Everyone’s trying to avoid that. Back to having the opportunity of a care plan that hopefully involves the outpatient setting and involves potentially case management, and looking at where the patient resides or works, what may trigger a flare, or how often it’s going to happen, and then being able to work with an infusion center, sometimes even an urgent center that has rapid access to the medication. [A place where] if a patient is feeling a breakout, they can immediately go. Then back to issues like are they open 24/7? These are logistics, but at least it gives patients different options. One of them may even be a local ED [emergency department], frankly, depending on how rural they may be located, or where there’s access and 24/7 availability.
This is a rare condition, and as a payer, I think in terms of per million members, how many members am I going to have who are so severe that I have to think about connecting the dots so that they get the care without delay? We will rely on experts, such as those on this panel, and it’ll be case by case in terms of how we can make this work so they will have immediate access for a life-threatening flare.
Ryan Haumschild, PharmD, MS, MBA: You talked well about the operational considerations. You need to have an infusion center that’s open and available, and can see the patient, as well as have the medication on hand or is able to get it. Maybe some of our larger centers that typically see these patients in the clinic potentially could be an area of access for these patients. At the same time, maybe having some type of urgent precertification workflow, so if there is a patient who has seen the diagnosis and severity, and who we want to treat in the outpatient setting to reduce that total cost of care, how do we get that treatment right away? Because otherwise, if we can’t get that treatment, I’ve seen providers frequently decide to admit the patient because, at the end of the day, they want to treat the patient above everything else. If there are any delays to treatment, they’re going to admit them and get them treatment in that inpatient phase of care. I think that important close consideration has to be well thought out, especially for a rare disease where maybe it’s not going to happen as frequently.
Transcript edited for clarity.