Management Optimization in Atopic Dermatitis - Episode 15

The Future of Atopic Dermatitis

Peter L. Salgo, MD: You know what, it’s been a tremendous discussion, and we’ve covered a huge amount of data all the way from psoriasis to AD to United States fiscal policy and the plight of the insurer who’s actually got to foot the bill for all of this. This is just a tremendous discussion, one of the better ones I can remember doing for this group. But, unfortunately, the clock is our master at this point. I don’t want to leave without giving each of you an opportunity for saying whatever you’d like to say just briefly, uninterrupted and uncontroverted. Cheryl, you’ve got about 30 seconds to a minute. Why don’t you start?

Cheryl Allen, BS Pharm, MBA: I’m on the hot seat. Alright. Well, thank you for the great discussion this afternoon. As I think about this for specialty pharmacy, this is a new forefront. While we have been working with the dermatologists, this is a new patient population for us. I think education there with the specialty pharmacies is on the pipeline. So, the National Association of Specialty Pharmacy will be doing that next week to get the information out there. I think there should be education to the stakeholders in general. We talked about patient education on injection site training. That’s something that, as we move from the topicals into these injectables, is in the pipeline. These are patients who likely haven’t used injections before. We’ll need to make sure, together, as the community, as the manufacturers, the doctors, the payers, and the pharmacies, that we’re working with these patients to stay compliant.

Peter L. Salgo, MD: Jeffrey, you’re up.

Jeffrey D. Dunn, PharmD, MBA: This has been fascinating and a great discussion. It’s nice when you get different stakeholders in the room and have these types of discussions because I think it’s enlightening to everybody, and we all learn. Again, I think to summarize, atopic dermatitis is a disease state that’s not on the radar screen right now. It will be with these drugs. There is a huge unmet need in terms of education. Again, we’re going from generics and over-the-counters to potentially expensive medications, so, with that, it’s understanding who the appropriate patient is. But a lot of what we’re talking about here is not that different from just the system in general. Again, to me, it’s about aligning incentives. Because, quite honestly, the incentive from a pharmaceutical company is going to be different than a payer or even a SP (specialty pharmacy), and it’s about talking about risk. And the unfortunate reality is the great science that we have comes at a huge cost, and we don’t have an open bucket when it comes to dollars. So, we have to do a better job of managing and, with that, spreading risk and aligning incentives.

Peter L. Salgo, MD: Ed.

Ed Pezalla, MD, MPH: I think that this has been a great discussion. The really important thing here is that everybody has mentioned the patient and that’s why we’re in this business. We have to think about the patient’s well-being from a number of different standpoints. Their toleration of risk versus the disease process that they have to treat and take care of, that’s going to be extremely important; what they’re willing to put up with or not put up with and how much they want to be cured or how much they want to control the disease. At the same time, they have a financial stake in this, as well, and so overtreating patients does them no good, either from a clinical or a financial point of view. So, we want to make sure that we align those things properly. But for those patients who really need the disease, we need to be reasonable, and we need to be sure that we can all find a way to work together, whether it’s basically being able to transmit data, to come up with the right definitions, or to figure out who it’s working for. But there are many things we can do. We have to keep the patient in mind though.

Peter L. Salgo, MD: Jonathan, you got the last word.

Jonathan Silverberg, MD, PhD, MPH: Thank you. I really enjoyed the conversation. I think it was an excellent discussion. I really agree with everything that was said. Right now, we’re on the precipice of what is being called the decade of eczema or atopic dermatitis, where the last decade was the decade of psoriasis. Pharma, patient organizations, everyone is starting to take interest in this disease state. So, it’s not just that it’s been off the radar of payers, it’s been off the radar of a lot of folks, unfortunately. And I think we have an opportunity now to really improve patient care and give patients back their lives, where they’ve been miserable, literally, for decades. And so, it’s something that I think is very promising, very exciting. I look forward to future discussions like this because I think we need them in order to advance the field.

Peter L. Salgo, MD: I want to thank all of you for being here. This has been informative for me. It’s a disease that wasn’t on my radar screen, frankly, but the misery has been because I know people with this disease, and they are not happy most of the time. On behalf of our panel, I want to thank you for joining us. I hope you found this program informative. I’m Dr. Peter Salgo, and we’ll see you next time.