Pharmacy & Therapeutics - June 2008 - (Page 366)

Dermatology Trends in Managed Care To what extent do you manage the use of phototherapy treatment for psoriasis? 11.7% No coverage At what price point do dermatology medication copays become too expensive for your patients? $100 $75–$99 $50–$74 $25–49 21.2% 1.0% 1.0% 19.2% 4.0% 3.0% 21.2% 32.3% 24.9% 29.3% 47.8% 53.7% 6.6% 12.9% 14.9% 2.0% 2.0% 2.5% 0% 10% 20% 30% 40% 50% 60% 23.4% Injectable Oral Topical Require prior authorization Copay of phototherapy visits Cover with no prior authorization or copay required 14.3% 51.9% Figure 3 Use of light therapy for psoriasis. (From The Galderma Quality Report for Dermatology & Managed Care, Volume II, 2007.) $11–$24 $0–$10 pays into their treatment decisions (Figure 4). As for billing and reimbursement, two-thirds of dermatologists surveyed said that their interaction with most managed-care plans was improving, as measured by quicker and more accurate payments. Nevertheless, dermatologists also expressed concern about frequent denials of paper claims and reimbursement for surgical procedures that are combined with office visits. Ac- Figure 4 Factoring patient copayments into treatment decisions for dermatological agents. (From The Galderma Quality Report for Dermatology & Managed Care, Volume II, 2007.) cording to Dr. James Zalla, a dermatologist in Kentucky, and a Galderma Quality Report advisor, surgical procedures should be payable separately if they are performed and billed at the Table 1 Tiers for Dermatology Medications Tier 1 Acitretin Accutane Benzamycin BenzaClin Capex Shampoo Clobetasol Clobex Cyclosporine Differin Dovonex Duac Finacea Gel 15% Isotretinoin Luxiq MetroCream MetroGel 1% Methotrexate Noritate Cream 1% Olux Retin-A Retin-A Micro Tazorac Tretinoin 14 (20.3%) 9 (12.9%) 19 (27.1%) 9 (12.9%) 8 (11.4%) 53 (75.7%) 8 (11.4%) 52 (74.3%) 9 (12.9%) 11 (15.7%) 5 (7.1%) 4 (5.7%) 50 (71.4%) 5 (7.1%) 13 (18.6%) 12 (17.1%) 61 (87.1%) 9 (13.0%) 4 (5.8%) 12 (17.1%) 4 (5.7%) 7 (10.0%) 49 (70.0%) Tier 2 17 (24.6%) 17 (24.3%) 25 (35.7%) 25 (35.7%) 22 (31.4%) 8 (11.4%) 17 (24.3%) 6 (8.6%) 23 (32.9%) 34 (48.6%) 21 (30.0%) 21 (30.0%) 3 (4.3%) 10 (14.3%) 30 (42.9%) 41 (58.6%) 5 (7.1%) 23 (33.3%) 11 (15.9%) 12 (17.1%) 15 (21.4%) 23 (32.9%) 8 (11.4%) Tier 3 24 (34.8%) 29 (41.4%) 14 (20.0%) 21 (30.0%) 19 (27.1%) 3 (4.3%) 27 (38.6%) 3 (4.3%) 26 (37.1%) 17 (24.3%) 26 (37.1%) 22 (31.4%) 7 (10.0%) 33 (47.1%) 19 (27.1%) 12 (17.1%) 2 (2.9%) 20 (29.0%) 30 (43.5%) 29 (41.4%) 29 (41.4%) 23 (32.9%) 5 (7.1%) Tier 4 1 (1.4%) 3 (4.3%) 0 (0.0%) 0 (0.0%) 1 (1.4%) 0 (0.0%) 1 (1.4%) 2 (2.9%) 0 (0.0%) 3 (4.3%) 2 (2.9%) 0 (0.0%) 1 (1.4%) 3 (4.3%) 2 (2.9%) 1 (1.4%) 1 (1.4%) 1 (1.4%) 2 (2.9%) 2 (2.9%) 2 (2.9%) 3 (4.3%) 2 (2.9%) Not Covered 13 (18.8%) 12 (17.1%) 12 (17.1%) 15 (21.4%) 20 (28.6%) 6 (8.6% 17 (24.3%) 7 (10.0%) 12 (17.1%) 5 (7.1%) 16 (22.9%) 23 (32.9%) 9 (12.9%) 19 (27.1%) 6 (8.6%) 4 (5.7%) 1 (1.4%) 16 (23.2%) 22 (31.9%) 15 (21.4%) 20 (28.6%) 14 (20.0%) 6 (8.6%) Total 69 (100.0%) 70 (100.0%) 70 (100.0%) 70 (100.0%) 70 (100.0%) 70 (100.0%) 70 (100.0%) 70 (100.0%) 70 (100.0%) 70 (100.0%) 70 (100.0%) 70 (100.0%) 70 (100.0%) 70 (100.0%) 70 (100.0%) 70 (100.0%) 70 (100.0%) 69 (100.0%) 69 (100.0%) 70 (100.0%) 70 (100.0%) 70 (100.0%) 70 (100.0%) From The Galderma Quality Report for Dermatology & Managed Care, Volume II, 2007. 366 P&T® • June 2008 • Vol. 33 No. 6

Table of Contents Feed for the Digital Edition of Pharmacy & Therapeutics - June 2008

Editorial Aliskiren Reduces Plasma Renin Activity Medication Errors Prescription: Washington New Drugs/Drug News/ New Medical Devices Drug Forecast Challenges in Evaluating and Standardizing Medical Devices in Health Care Facilities California e-Pedigree Rules Pose Challenges For Pharmacies Pharmaceutical Approval Update American Psychiatric Association At a Glance: Dermatology Trends in Managed Care

Pharmacy & Therapeutics - June 2008

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