How to Set Up Afamelanotide Treatment for Patients With EPP

In this Dermatology Times Expert Perspectives video series episode, Elizabeth Buzney, MD, a dermatologist at Brigham and Women's Hospital and part of Mass General Brigham Dermatology in Boston, Massachusetts, outlined the practical steps required to offer afamelanotide implants to patients with erythropoietic protoporphyria (EPP). Her comments covered office preparation, prior authorization timing, and patient counseling at the consultative visit.

Preparing the Practice for Afamelanotide Implants

Buzney said the dermatologist or physician extender administering the implant should be trained in proper insertion technique. Cold storage for the medication is also required, along with a shipping process that allows the medication to be received and stored appropriately. "This requires a good amount of coordination between the EMR that you're using, between your pharmacy, the provider team, and then also the billing team as well," Buzney said.

Navigating Prior Authorization Timelines

The prior authorization process for afamelanotide typically takes 6 to 8 weeks, according to Buzney. She said financial logistics should be resolved for the patient before the first dose is administered. The full care team should also be familiar with the needs and setup specific to patients with EPP, so visits run efficiently. "I always do a consultative visit first, where I talk all about the medication, and I go through all of those practical considerations, including the financial part of it, before we submit the prior authorization," Buzney said.

Counseling Patients Before Treatment

At the consultation visit, Buzney discusses what patients should expect, including the timeline for photoprotection improvement and normal pigmentation changes associated with treatment. She also counsels patients on avoiding excessive UV exposure or tanning behaviors and on timing treatment, such as starting before a high sunlight season like spring for maximal benefit. Buzney noted the implant insertion involves injecting lidocaine with epinephrine for numbing before placing the afamelanotide implant. "That numbing medication is, is, is painful, just as it would be with any lidocaine with epinephrine injection for a biopsy," she said.

Impact on Patient Quality of Life

Buzney described caring for patients with EPP as rewarding, noting many patients experience a profound difference in quality of life once treatment works for them. "It really feels like, again, making a difference in a way that I don't always do for all of my patients," Buzney said. She added patients often feel validated by treatment, having previously lacked a community where others believed and understood the impact of their symptoms.