Navigating Topical Treatment Access and Escalating to Systemic Therapy

When choosing between roflumilast foam and cream, clinicians emphasize simplicity and patient preference. Both formulations are effective, but the foam is often favored—even for non–hair-bearing areas—because of its light texture, nongreasy feel, and elegant vehicle. In practice, physicians often let patients try both in the office (where samples are available), allowing them to choose based on personal comfort. This “choose-your-own-adventure” approach increases patient buy-in, enhances adherence, and accounts for individual needs such as using cream in intertriginous areas and foam on the scalp.

Navigating insurance approvals remains a key hurdle, and clinicians share best practices to streamline access. Thorough documentation is critical, detailing prior treatment failures (topical corticosteroids, calcineurin inhibitors, vitamin D analogs) and setting up the case for systemic consideration if needed. Specialty pharmacies play a vital role by managing prior authorizations, applying coupons, and reducing out-of-pocket costs and logistical burden. Correct International Classification of Diseases, Tenth Revision coding is also essential, as vague or incorrect codes can trigger denials. With the right systems in place, some patients report seamless experiences, including direct shipment and minimal wait times.

More broadly, the discussion reflects a paradigm shift in topical psoriasis treatment. With well-tolerated, nonsteroidal options such as roflumilast, topicals are no longer limited to just mild disease; they’re now seen as viable for special sites (eg, scalp, hands) and for patients who may not be ready for systemics. Improved adherence from simpler regimens (eg, 1 product once daily) reduces treatment burden and may even delay or eliminate the need for escalation. Although topical corticosteroids are still useful—particularly for short-term flares—these newer agents could take a more prominent, first-line role, pending coverage and cost considerations. This evolving landscape is empowering clinicians and patients alike with more flexibility and individualized care.