Ensuring Patient Access to Effective and Affordable Treatments Remains a Top Priority for the AAD

In an interview with Dermatology Practice Management (DPM), Bruce H. Thiers, MD, FAAD, President, American Academy of Dermatology (AAD), explains how the organization, together with its sister organization, the American Academy of Dermatology Association (AADA), are working closely with federal, state, and local organizations to overcome access to care barriers for patients with dermatologic conditions.

DPM: What are the foremost access challenges facing dermatology providers and their patients?

Dr Thiers: Dermatologists treat more than 3000 conditions of the hair, skin, and nails. We are committed to providing the highest quality patient care and do our best to serve the communities we live in.

The AAD gives a voice to the specialty, providing our members with valuable resources and tools to adapt to the shifting healthcare landscape and engaging with stakeholders to ensure access to care for patients. There are several access-related priorities that the AAD is working on, but currently the foremost challenges faced by dermatologists and their patients include the following:

  • Teledermatology. Teledermatology is a powerful tool for increasing patient access to needed dermatologic evaluation, especially during the current COVID-19 public health emergency, as it can help new patients initiate care and established patients maintain their treatment plans. Although many patients face difficulties accessing specialty providers throughout the healthcare system, these issues are not limited to 1 patient group, as they cross socioeconomic, racial, geographic, and age boundaries.
    The AAD advocates for innovative telehealth policies and programs that will help increase access to care for everyone, especially in populations that need it the most.
  • Pharmaceutical Access and Affordability. Dermatologists are committed to providing the most effective, cost-efficient care and pharmaceutical therapies to their patients. A variety of factors have affected patients’ access to treatment, including market forces that have led to consolidation of drug manufacturers, slow approval processes for new generic and specialty drugs, policies that restrict physicians’ abilities to prescribe preferred treatments, and more.

The AAD believes that treatment decisions are best made by physicians together with their patients. Policies such as prior authorization, which require insurance company approval of certain drugs, place a third party with limited knowledge of the complexity or full history of a patient’s condition in a decision-making position and impede patient access to the most effective treatments. Furthermore, step therapy or “fail first” strategies are a tool used by health plans to control spending, but these policies also negatively affect patients by creating unnecessary delays and impeding the receipt of optimal treatment.

As dermatologists, we understand the intercurrent factors (eg, efficacy and safety of all treatment options, comorbidities, and the patient’s support system) necessary for making a treatment determination that works best for a specific patient.

DPM: Is the AAD partnering with any other medical or patient advocacy organizations to address these issues at the federal or state levels?

Dr Thiers: The AADA is the sister organization of the AAD that focuses on government affairs, health policy, and practice information. The AADA advocates on behalf of the specialty at the local, state, and federal levels, including through partnerships and coalitions to move the needle forward as it relates to the Academy’s priorities. Our partners include dermatology sister societies, the American Medical Association, state medical societies, other medical specialty organizations, and national- and state-based patient advocacy groups.

Often, we will collaborate on opposition and support letters sent to policymakers as well as media relations efforts to raise awareness.

DPM: How is the AADA advising practices at the national level? Are there local chapters to advise on regional issues? How are these advocacy efforts coordinated?

Dr Thiers: The AADA aligns federal, state, and local efforts when deploying strategies to improve the specialty and treating patients. State advocacy efforts include partnering with state medical and dermatology societies on issues such as:

  • Access to pharmaceuticals/cost transparency
  • Healthcare truth in advertising
  • Scope of practice
  • Indoor tanning legislation/skin cancer prevention
  • Insurance network adequacy and transparency
  • Medical spa standards of practice
  • Telemedicine
  • Access to compounded treatments
  • Biosimilars
  • Cosmetic procedure taxes and medical provider taxes
  • Office-based surgery

The AADA offers resources to support state level advocacy efforts, including model bills and bill drafting, legislative and regulatory analysis, grassroots strategy, testimony preparation, and grant assistance to states for specific advocacy initiatives. In addition, the AADA often works in coalitions to advance its advocacy agenda, including scope of practice, truth-in-advertising, and step therapy reform. The AADA connects local and state societies to coalition members in their state.

DPM: What is the AAD’s position on access to biologics?

Dr Thiers: Biological products play a prominent role in dermatologic care and are increasingly important as they continue to come to market. We are encouraged by innovation in this space; however, we have concerns about formulary restrictions, patent thickets, pay for delay, and Risk Evaluation and Mitigation Strategy requirements.

Biosimilars hold promise in driving competition and providing additional access options for patients in the biological products market, which could ultimately increase access to appropriate therapies for patients with serious and chronic conditions and could facilitate increased patient adherence to prescribed medications. However, biosimilars must be carefully evaluated by a patient’s physician and healthcare team to determine the benefits and risks of a biosimilar substitution.

The AADA has joined several patient and specialty organizations in developing biosimilar principles in support of increasing uptake of biosimilar biological products, which include:

  • Patient trust in the safety and efficacy of biosimilars, and physician confidence in prescribing them, are crucial factors for driving broader uptake.
  • The language healthcare stakeholders use to talk about biosimilars matters.
  • Public policies play a critical role in fostering increased access and competition in the biological products market.

More work must be done to educate patients, physicians, and other healthcare stakeholders that appropriate access to all biological products, including biosimilars, is critical to fulfilling the promise of lower out-of-pocket costs for patients.

DPM: In terms of access to biologics, what are the AAD’s goals for 2020 and beyond?

Dr Thiers: The AAD encourages policymakers, reference product manufacturers, biosimilars manufacturers, payers, pharmacy benefit managers, and employers to join us in our efforts to lay the groundwork for a thriving biologics market, which includes biosimilars.

The AAD supports policies that demonstrate a balanced approach to improving patient access to medicines by ensuring that commercial health plans provide an expeditious, transparent, and reasonable step therapy appeals process. In addition, the AAD advocates with Congress to standardize how prior authorization determinations are made. Although many of these protocols come with significant administrative burden, the ultimate policy goal is for our patients to receive the appropriate medication at the right time.

DPM: Have payers loosened access barriers in response to the COVID-19 public health emergency?

Dr Thiers: The COVID-19 pandemic has created a significant change in the delivery of healthcare services. Early on, payers relaxed provisions on telehealth requirements, so that physicians could continue to provide care and patients could maintain needed therapies.

Many payers have expanded access by removing platform barriers and providing consistency in coding and reimbursement. This reduces hurdles during this unprecedented time and recognizes the value of the physician–patient relationship. The Centers for Medicare & Medicaid Services has led the way in providing consistency in telemedicine policies, while some insurers need to harmonize the disparate requirements physicians are facing.

With any new process, challenges remain. The AAD believes that teledermatology is a powerful tool for increasing patient access to needed dermatologic care and looks forward to working with insurers to identify how telemedicine can continue to improve the delivery of patient care now and beyond the current public health emergency.

DPM: Does the AADA engage directly with payer organizations or purchasers of healthcare (ie, employers)? If so, what have those discussions yielded?

Dr Thiers: The AADA does engage directly with payers on a myriad of issues, including reimbursement, coding, prior authorization, and step therapy protocols. We continue to foster relationships with payers to serve as a reliable resource for insights on policy impacts on patient care and to productively work through issues that have the potential to affect the specialty and our patients.

In addition, some insurance companies, such as Anthem, Cigna, Humana, and UnitedHealthcare, have delayed or canceled implementation of reimbursement and coverage policies that could have hindered patient access to dermatologic care and the therapies dermatologists prescribe.

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