Ryan Haumschild, PharmD, MS, MBA: There are still challenges because not everyone has that model. Many of these patients are still treated in the community. Dr. Lopes, what are some of the challenges around access to care? What are some of the patient education or financial burdens for all skin phototypes?
Maria Lopes, physician, MS: In terms of access to care, patients in many communities have to travel — sometimes 50 miles — to see a dermatologist or a rheumatologist. The next available appointment may not be until 3 or 4 months later. The job of what a best practice looks like is to create awareness and help PCPs [primary care physicians] start the identification, the diagnosis and the start of the treatment. The other is the time factor. These patients take a lot of time. Especially in a PCP world, they look at comorbidities rather than psoriasis as a condition. There are also quality measures. You are scored based on things like diabetes, hypertension, and dyslipidemia. There is a large overlap with psoriasis, but the focus is on the other comorbidities and not psoriasis per se.
How do we ensure a more holistic and integrated approach? On the financial side, the reality of financial toxicity is growing. More specialty drugs fall into co-insurance, not co-pays but co-insurance. Some drugs are excluded from the formulary because many payers do not cover every drug in every category of every mechanism of action. Some may be covered and preferred, but even those that are preferred may have co-insurance. dr [Bruce] Sherman alluded to the patient’s out-of-pocket costs. While the accumulators ultimately seem benevolent, patients are faced with the reality of, “What’s this going to cost?” They may have started treatment. Although the treatment is effective, they eventually stop the treatment because they cannot afford it. [We need to be able] manage patients properly.
There are also co-pay maximizers, which amortize the value of that coupon over a calendar year. Essentially, this allows for more predictability around patient out-of-pocket costs and, hopefully, more compliance. I totally agree. The integration of a care team consists of a clinical pharmacist and a social worker. Many of these patients have many psychosocial problems: transportation needs, sometimes even housing. If we don’t ask, we don’t know.
It’s also about what happens between office visits. An office visit will always be very short. Capturing meaningful and up-to-date information between office visits gives the clinician insight into how the patient is doing, rather than relying on the patient to tell us in that minute. They may not even remember what happened in the past 3 to 6 months. Part of the value of emphasizing what matters may come from technology. It helps to have more shared decision-making, but also a much more efficient process, in terms of what that dialogue looks like between the patient and the clinician, including the GP. This points to challenges, but also opportunities to do better.
Ryan Haumschild, PharmD, MS, MBA: It does. It sounds like there are many opportunities for organizations to make an impact.
Transcript edited for clarity.