Shanna Miranti, MPAS, PA-C, Shares Highlights From Diversity in Dermatology Meeting

At the 2024 Diversity in Dermatology meeting in San Antonio, Texas, Shanna Miranti, MPAS, PA-C, presented her session, “Conquering the Denial Hurdles – Getting Your Patient on the Right Drug.” Miranti, a board-certified physician assistant at Riverchase Dermatology in Naples, Florida, and Dermatology Times’ Summer Editor in Chief, also participated in a women’s empowerment panel alongside Risha Bellomo, CEO; Terry Faleye, PA-C; Latanya Benjamin, MD; Raquelle Akavan, PA-C; Lindita Vinca, DNP, ARNP; and Archana Sangha, PA-C.

During her access session, Miranti discussed the struggle of helping patients receive the latest therapeutics due to new processes for specialty medications and completing prior authorization forms. Using atopic dermatitis as an example, Miranti noted that clinicians may have to move their patients through the steps of trying and failing a topical corticosteroid or topical calcineurin inhibitor before being able to move patients on to some of the newer therapeutics.

“In addition to knowing the latest and greatest prescriptions for our patients and what might be the next step, we also really have to familiarize ourselves with the process of getting this prescription into our patients’ hands. Oftentimes, that means we will have to go through the dreaded prior authorization process,” Miranti told Dermatology Times.

While presenting during the women’s empowerment panel, Miranti and her colleagues discussed how they juggle motherhood and their careers.

“As one of the leaders on stage pointed out, there is no such thing as work-life balance. It's all a juggling act, and you have to truly make time for the things that are important in your life. As a mother of 4, this is something that resonates in my everyday life,” said Miranti.

Transcript

Shanna Miranti, MPAS, PA-C: Hi, my name is Shanna Miranti, and I'm a physician assistant with Riverchase Dermatology in Naples, Florida.

Dermatology Times: Can you please provide an overview of the 2024 Diversity in Dermatology meeting and your leadership role?

Miranti: This year's Diversity in Dermatology conference was our third live conference; it was held in San Antonio, Texas. It was a fantastic opportunity to learn from each other. We had phenomenal KOLs, some of the absolute best speakers in the nation at our conference giving really wonderful lectures on a wide variety of topics. This is a conference that is unlike any other. It is an organization that is specifically geared toward APPs, nurse practitioners and physician assistants in dermatology. It is a nationwide organization that focuses on education for not only diversity of skin tones, but diversity in topics, diversity in our career choices. So, we really did have a fantastic meeting full of a lot of wonderful opportunities for education, and also opportunities to learn from each other. We had a skin care showcase highlighted by Dr. Latanya Benjamin, who was phenomenal. So, a lot of really deep dives into options for our patients just beyond even our prescription pad. So, if you have the opportunity, come check out Diversity in Dermatology. It is a wonderful conference, and I hope you can join us next year.

At the recent conference Diversity in Dermatology, I gave a talk regarding access to medications. This is a really hot topic right now because of course, there are so many amazing medications that are coming out for our patients. But if our patients can't get access to them, then they're not going to do our patients any good. So, I gave a talk just talking through the points of how this process has gotten so complicated. Those of us who have been in practice, for over 10 years or even over 20 years, remember the days when we could just hand a patient a prescription and they could walk out of our office and take it to their friendly local pharmacist. And then pharmacists would actually have that medication on their shelf, and they could walk home with a medication for little to no out-of-pocket cost. Unfortunately, that's just not the case anymore. Specialty medications now often require a special process in order to get them. And so, we as providers need to become confident and familiar with those processes in order to get our patients access to those medications.

Dermatology Times: What key highlights did you cover in your Diversity in Dermatology session, "Conquering the Denial Hurdles?"

Miranti: I think we have to remember that we are a sought-after specialty. Patients often wait weeks to months to come see us and they will be paying a specialty copay often to see us in our practices. So, we should not just offer our patients generics that have been around for 20, 30, or 50 years, or generics that they may have already tried and failed previously with their primary care physician. I think as dermatology providers, we need to remember to actually kind of familiarize ourselves with patients' formularies. Sometimes there will be step edits. And we will actually have to work through these steps. We will have to try and fail a triamcinolone, a topical corticosteroid, and a topical calcineurin inhibitor, for example, when we're trying to move on to another medication for atopic dermatitis.

Or in the acne realm, they may already have tried and failed, topical generic tretinoin and topical clindamycin. So, we should not just have a prefilled-out prescription in our hands and give this to our patient. We need to dive a little deeper and find out what they have already been on and what they have tried and failed. Oftentimes patients don't know that. They may not remember the name of medications. They often say, "I remember it was the cream in the tube with the letters on it." There's just sometimes not that recollection and familiarity with the names as we have them. So, there are some tips and tricks that we can do to figure out what patients have previously tried and failed. In most EMA's or other different practice management type of software, there are abilities to go in and look at the patient record and actually, with the patient's permission, view their pharmacy history and what they have actually gotten filled at local pharmacies. So, we need to familiarize ourselves with that process and actually be able to import those medications from the patient's pharmacy. In addition to that, we need to know what the next best step is to take if this patient has already tried other medications, we need to move on to the next latest and greatest.So, know our science. It's really important to know those latest and greatest medications, know them inside and out. Know the safety and the efficacy and make sure that you're able to very confidently portray that to your patient.

Dermatology Times: What tips or steps did you share with attendees on how to ensure your patients get the drug they need?

Miranti: In addition to knowing the latest and greatest prescriptions for our patients, and what might be the next step, we also really have to familiarize ourselves with the process of getting this prescription into our patients' hands. Oftentimes, that means we will have to go through the dreaded prior authorization process. And I think that this is something that you know, as soon as you mention the word prior authorization, you can hear an audible groan from those of us that actually work in the fields of dermatology. But unfortunately, it's become a very necessary part of our daily life and our daily work life situation. So, it's very important to not only work those electronic prior authorizations, but to also familiarize yourself with Cover My Meds and other prior authorization processes that may be specific to the medication that you're trying to get for your patient. Industry can actually help us tremendously with this process. We now have patient access managers, and field reimbursement managers at our fingertips, and they can be our guide to help us work through prior authorizations, step edits, and difficult roadmaps that may be in our way and those difficult hurdles that may be in our way to trying to get our patients access to medications. Again, if you're not completely comfortable with the prior authorization process, or maybe you're getting denial after denial, after denial, reach out to these industry partners that can help us, or reach out to biologic coordinators. Even in our practice, we do not have a biologic coordinator. But there are so many opportunities for maybe even having a biologic coordinator remotely work for your practice. There are companies out there that can do AI-type prior authorizations. So even if your practice does not have the manpower to be able to work through a lot of these processes, there can be ways to automate these processes, or outsource these processes, again, to get our patients better experience and to ultimately get our patients better medications.

Dermatology Times: What advice did you share during the "Women Empowerment Panel?"

Miranti: In addition to my lecture, on access to medications, I also have the opportunity to be part of the women's empowerment panel at Diversity in Dermatology. This was a fantastic networking opportunity where 5 or 6 of us were able to get on stage and just talk about our careers in dermatology, how we came into dermatology, how we juggle motherhood, and working, and life, and keep that work-life balance. And as one of the leaders on stage pointed out, there is no such thing as work-life balance. It's all a juggling act, and you really have to truly make time for the things that are important in your life. As a mother of 4, this is something that resonates in my everyday life. I love my children dearly. And I really do miss out on some things when I'm traveling and speaking and going to conferences. So, it's really important to get connected with an organization that sees the opportunities within you and also kind of helps you improve your personal and professional development.

[Transcript lightly edited for space and clarity.]