Survey spotlights managed care challenges

The Galderma Quality Report for Dermatology & Managed Care incorporates responses from 73 medical directors, pharmacy directors and other key U.S. managed healthcare decision-makers, as well as from 330 dermatologists around the country. While the report contains few surprises, it's among the first attempts to shed light on long-standing - and some not-so-long-standing - problems.

"It was very well done, and it basically corroborates our significant concerns regarding managed care. This study is perhaps more valuable for our colleagues in the insurance industry than for dermatologists because it addresses the significant lack of concern that the insurance industry has shown for a two-way partnership with dermatologists. Each dermatologist knows personally the incredible amounts of time that we spend doing things like prior approvals and performing prescription callbacks and insurance-related benefit guarantees," he says.

"This pertains to formulary, prior approval and other information. Another point regarding managed care that the majority of dermatologists (surveyed) believed is that carriers were inconsistent about their approval of medications and procedures, with the exact same diagnosis and treatment prescribed."

Structure of care changing "Overall," Dr. Fleischer says, "the structure of dermatologic care is changing. For instance, the vast majority (90 percent) of dermatologists believed that in the next year, they would be prescribing more biologic treatments for psoriasis. These biologic treatments are very effective and offer limited toxicity. On the other hand, they carry enormous expense. As a result of those costs, it behooves managed care organizations to understand why patients fail lesser treatments."

Often, insurers treat topical preparations as equal, Dr. Fleischer notes. "But if a drug is in a non-elegant vehicle, patients don't like, they won't use it, and cost-effective treatment will fail. Failure of topical drugs may be adequate to justify use of systemic biologic agents for psoriasis."

In the survey, 72 percent of pharmaceutical companies surveyed included injectable biologics for dermatological conditions on formulary.

However, Dr. Schlessinger says, "Managed care companies can't say that they won't cover biologics. But what they can do is to economically credential those doctors who use biologics appropriately and intimidate them into their way of thinking."