Managed care

June 1, 2007

A Galderma sponsored quality report points toward where things are good in the industry, where improvements still need to be made and issues of continued debate.

Key Points

National report - A comprehensive report on the state of the union of dermatology and managed care shows that dermatologists welcome changes ranging from greater insurance coverage of biologics to faster and more accurate claims payment.

However, concerns persist about problems including increased co-pays, inconsistent coverage policies and frequent denials, particularly of bundled claims, according to the second edition of the Galderma Quality Report for Dermatology & Managed Care.

What hampers patient access to biologics?

"There is more acceptance by many - but not all - managed care companies of going straight to biologics, where it's indicated," in accordance with an AAD position paper on the topic, Dr. Stone says.

However, he says, "Prior authorization is still a problem with both biologics and UV therapy."

Perhaps more important, Dr. Stone says, "Part of the problem with biologics is that some companies are approving them, but the cost-sharing to the patient makes them unusable.

Vehicles drive success

Dr. Feldman says the availability of new topical agents in foams, shampoos, sprays and lotions "makes it much easier for us to find a treatment the patient will actually use, which is 90 percent of the battle in psoriasis."

However, Dr. Stone says the fact that 92 percent of managed care respondents either agreed or strongly agreed that generic steroids are as efficacious as branded steroids, regardless of vehicle, is "a problem. That's never been demonstrated in a scientific fashion."

Dr. Stone says that although he uses generics where appropriate, "I'm not convinced that generic topical medications are the therapeutic equivalent of brand-name products."

While some vehicles enhance penetration, he says that others, "even with the same drug, give different degrees of both in vitro and in vivo efficacy."

Clinically, he adds, "There are certain times - especially when I'm running into difficulties with a patient - where I want to know that the patient is getting the particular product that I want."