Expert Perspectives in the Management of Atopic Dermatitis in Skin of Color - Episode 14

Access to Dupilumab for the Management of Atopic Dermatitis

Andrew Alexis, MD, MPH, FAAD: How about access? That’s a real-world situation. We have these amazing medicines, but sometimes it’s just plain and simple difficult for patients to get them. What’s been your experience as far as getting access to dupilumab, Jamie?

Jamie Weisman, MD: It’s not always easy, but it’s gotten more accessible. The impact on patients has become so obvious to payers, so we have access—at least in Atlanta—across a variety of payers, from Medicaid to private insurance. There are bridge programs if we need them. We’ve done a good job. I’m going to thank the people on this panel, as well as the other members of the American Academy of Dermatology, for making the payers aware of the effect of this disease on our pediatric and adult patients. The more we advocate for our patients and, of course, the patients advocate for themselves, the easier it is to get the medication. I have found that when I do want it, I can get it for my patients. Sometimes it’s easy; sometimes it takes more work. But if you advocate for your patients, you can get it.

Andrew Alexis, MD, MPH, FAAD: Yes, that is key. Candrice, I don’t have as much of a pediatric population as you. Do you find that there are differences in access to dupilumab for your patients who are children—ages 6 to 11, for example—compared with adults?

Candrice Heath, MD: Age was the factor that held up some children from becoming good candidates from the insurance perspective. But now that the age group has been dropped down to 6, it is a lot easier. What I found, in my pediatric population as well as my adult population, is that documentation is important—documenting everything that they have tried, making sure that they have tried something that contains steroids and something that does not contain steroids, documenting how the atopic dermatitis affects their life. 

All those things can be helpful for prior authorization, including documenting things that you may not necessarily document as deep in a detailed way, like counseling about potential adverse events. I’ve even seen documentation that the conversation did not happen. Even if it did happen, it can get rejected for that reason, so documentation, documentation, documentation. It’s very important in order to get drugs covered. In my population, 50% of my patients have commercial insurance, and 50% have Medicaid. But if you look at all my patients with atopic dermatitis, we work hard to get those medications to the patients who need them, including medications like dupilumab that have a much higher price tag.

Andrew Alexis, MD, MPH, FAAD: Heather, what’s been your experience in terms of access?

Heather Woolery-Lloyd, MD: I don’t manage that part of the practice. In my experience, I have been using it in a research setting. Luckily, in a research setting, it’s not an issue. Everyone gets it. 

One thing I’ll tell you is that for people who are seeking more expensive options for eczema, look out for those studies because they are typically long studies. Some are 12- to 18-month studies, and patients not only get the medication for free but are compensated for their time because the study visits are time consuming. It’s usually at least an hour because it involves taking blood, but most of the time is spent on pictures, my evaluation, the patient’s evaluation, and questionnaires. Clinical studies are always an option for people where coverage is not an issue. A lot of my patients will say, “My dermatologist prescribed this drug, but we couldn’t get coverage,” and I found this study. 

Andrew Alexis, MD, MPH, FAAD: I’ll just touch on my own experience. I’ve been impressed with the access overall. I’ve been able to get dupilumab for most of my patients who need it. And to Candrice’s and Jamie’s points, you do need to advocate for your patients and document well.

In addition to documenting body surface area, documenting things like sleep disturbances is helpful, and other aspects that would affect the quality of life. That all helps build a strong case for getting approval for dupilumab. Thankfully, my experience has been good. If you advocate enough and have enough documentation, you’re successful in most cases.

Transcript Edited for Clarity