Why Medicare Patients Still Miss Out on Advanced Derm Therapy

Patients on Medicare often do everything insurers ask, including trying and failing the standard topicals, and still can’t get the advanced therapy they need. Louis Margulis made that point in an interview with Dermatology Times’ NP/PA Connect at the 2026 Horizons in Advanced Practice meeting in Atlanta, Georgia.

Margulis is a physician assistant practicing in Atlanta. He called getting the right medicine to his Medicare patients one of the biggest challenges he faces in practice.

Medicare Out-of-Pocket Costs Remain a Barrier to Advanced Therapy

Many of these patients are veterans, Margulis noted. Most have already failed the topicals and standard treatments that insurers require before approving other options.

“These people have done so much,” he said. “They’ve contributed so much to our country.”

Clearing the insurer’s hurdles doesn’t end the problem. Medicare patients still face a significant out-of-pocket threshold before their coverage fully applies. For many people on a fixed income, that amount is out of reach.

“Even with that Medicare, like, all you have to spend is $2,000, and then you get it,” Margulis told NP/PA Connect. “It’s like, they don’t have $2,000. It really breaks my heart.”

Higher Treatment Goals Raise the Stakes for Access

Part of what makes the access gap so frustrating is how much the treatment landscape has improved. Margulis pointed to the growing range of options clinicians now have and to how far expectations have shifted in psoriasis.

“Before, like psoriasis, if you were like half clear, that was considered like the goal, and now the goal is like 100% clear,” he said. “So that’s very exciting.”

In atopic dermatitis, Margulis described a layered approach to treatment. Clinicians first address the patient’s immediate symptoms. They then focus on “making sure that the skin barrier remains protected and healed,” he said, and sustain that protection over the long term.

How to Make Short Patient Visits Count

Margulis also highlighted a practical pearl from a meeting session on making the most of limited time with patients. Start by introducing yourself. Look the patient in the eye. Then ask which concern they’d most like help with first, and go from there. He said that simple sequence sets a useful framework for the rest of the visit.

He said it also helps to be honest that the visit’s time is shared. That means “recognizing that you’re there for them, but... they have things to do, we have things to do, there’s other patients to see too.”

When clinicians set that expectation up front, Margulis said, everybody gets what they need.

Learn more from Horizons in Advanced Practice here. Join dermatology NP and PA colleagues at Derm Nexus in November 2026.