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Why Patients with Skin Conditions Can’t Get Treated

Tens of millions of people across the United States are affected by skin conditions, but not all of them can access the doctors and medications they need.  So explains a new white paper from the Derma Care Access Network, an advocacy group that encourages informed policy on access to dermatological care.

As “Overcoming Barriers to Dermatological Treatment” explains, skin conditions vary from the cosmetic to the deadly. The paper calls out in particular:

  • Atopic dermatitis (commonly known as eczema), which affects more than 30 million Americans
  • Psoriasis, which affects 7.5 million
  • Acne, which affects as many as 50 million people
  • Chronic urticarial, which causes red, itchy welts, and which affects 15-20% of the population
  • Skin cancer, the most common cancer in the United States, which affects 5.4 million people and has an estimated 9,500 diagnoses every day.

Patients with skin conditions may also have comorbidities such as chronic pulmonary disease, diabetes, renal disease and rheumatic disease.  But obtaining treatment can be difficult.

Like all specialists, those that treat skin conditions – including dermatologists, allergists and immunologists, and rheumatologists – tend to cluster in densely populated areas or near academic research centers. Patients with moderate-to-severe skin conditions who need to see a specialist may have to weigh the cost and logistics of seeking care.  A shortage of dermatologists further complicates matters, resulting in long wait times.  And narrow health plan networks with few “in-network” providers can make access still harder.

The challenges don’t end there.  Biologic drugs used to treat skin conditions such as atopic dermatitis or psoriasis are frequently subject to prior authorization, meaning the patient and doctor must get the insurer’s permission before the drug is covered.  Some insurers require that patients try a less expensive treatment first, a process known as “fail first.”  The paper notes that some patients discontinue treatment as a result of fail first, which is especially problematic given the chronic nature of many skin conditions.

Patients who do finally get approved for a biologic may discover that the drug is on their health plan’s “specialty tier” of drugs – requiring high co-pays.

The hurdles are unfortunate, the paper argues, given that biologic drugs often provide dramatically better results for patients than the conventional, less costly drugs insurers prefer.  Health plan barriers can also effectively take treatment decisions out of doctors’ and patients’ hands – which, the paper argues, undermines individualized and patient-centered care.  

Untreated patients with psoriasis, eczema, skin cancer or other skin conditions bear the effect not only on their appearance but also on their overall health and ability to function at school, work and around the community.

Policymakers’ role, the paper concludes, is to impose commonsense reforms on when and how these techniques can be imposed.  The paper encourages policy at all levels that “reinforce[s] shared decision making between the patient and physician” and makes treatment more available for patients with skin conditions.

To learn more, read “Overcoming Barriers to Dermatological Treatment.”

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