Geospatial analysis of access to dermatology care in Los Angeles County: a cross sectional study.

Geographic maldistribution of dermatologists contributes to disparities in access to dermatologic care. We aimed to investigate the geographic distribution of, and differences in wait times for medical dermatology services in Los Angeles County (LAC). We placed phone calls to 251 dermatology practices in LAC to ask for a new patient appointment for a changing mole. We found West LAC (Service Planning Area [SPA] 5) had the highest number of dermatologists and South LAC (SPA 6) had the lowest (26.1 versus 0 per 100,000 residents, P=0.01). Service Planning Area 6 has a higher non-White, uninsured, and impoverished population than SPA 5. Dermatology appointment wait times and Medicaid acceptance varied between SPAs but was not statistically significant (P=0.37 and P=0.20, respectively). Medicaid-accepting practices had a significantly longer mean wait time for an appointment than practices that did not accept Medicaid (26.1 versus 15.1 days, P=0.003). Regions with predominantly non-White, Spanish-speaking, and medically underinsured residents were found to be disproportionately lacking in dermatologists across LAC, which may contribute to impaired access to dermatology services in LAC.

Allergen Composition, Marketing Claims, and Affordability of Pediatric Sunscreens.

BACKGROUND: Childhood sun exposure is associated with development of future skin cancers. Sunscreens are an important tool to prevent harmful ultraviolet rays. OBJECTIVES: The aims of the study are to evaluate sunscreens targeted to children and to analyze cost, marketing claims, ingredients, and allergens to help consumers select products. METHODS: The top 50 pediatric sunscreens across retailers were analyzed for their cost, marketing claims, ingredients, vehicles, and containers. Ingredients were compared with the American Contact Dermatology Society 2020 Core Allergen List. RESULTS: The mean price was $6.20 per ounce (range, $0.25-$39.98). The mean sun protection factor was 48.5 (range, 30-100; SD, 48.5). There was a mean of 17.5 ingredients and a mean of 1.1 allergens in products. On average, products marketed as "sensitive skin" were not only significantly more expensive ($8.90 vs $3.50 per ounce, P = 0.01) but also were significantly more likely to not contain any allergens (36.0%, n = 18 vs 12%, n = 6; P = 0.05). Products with mineral-only UV blockers were significantly less likely to have any allergen when compared with products that had chemical UV blockers (5.6%, n = 1 vs 94.4%, n = 17; P = 0.02). CONCLUSIONS: The current market of pediatric sunscreens varies significantly in price, marketing claims, and active ingredients. Products marked as suitable for sensitive skin had significantly fewer allergens, but a majority of these products still had at least one allergen. Many sunscreens contain contact allergens, which is an important selection consideration.

Demystifying pharmaceutical patient assistance programs.

Prescription drug costs impose a significant financial burden on the United States healthcare system. Patients with chronic dermatologic diseases often require long-term and expensive prescription drugs. In an effort to expand drug availability, pharmaceutical companies fund patient assistance programs (PAPs) to assist disadvantaged patients in gaining access to high-priced brand name medications with no suitable therapeutic alternative. Patients and clinical staff often face difficulty navigating the various PAPs. Herein, we seek to explore the utility, criteria, and challenges in PAPs and provide a practical discourse for dermatologists caring for medically indigent patients.

Medicare and medicaid spending trends for immunomodulators prescribed for dermatologic conditions.

Immunomodulators are the most expensive prescription medications used in dermatology for chronic skin conditions. Each year, rising costs for immunomodulators pose significant financial burdens on patients and the healthcare system as a whole. Using the Centers for Medicare and Medicaid Services (CMS) we collected Medicare Part D (Medicare-D) and Medicaid spending data for immunomodulators with dermatologic indications or off-label use from 2012-2018. The average annual spending and average annual spending per dosage unit (AASPDU) was calculated for each of the thirteen included medications. Combined Medicare-D and Medicaid spending increased 319.9% from $2.5B in 2012 to $10.6B in 2018, with an average of $6.2B spent annually. For both Medicare-D and Medicaid, adalimumab ($1.8B, $968.8 m), etanercept ($1.4B, $467.5 m), and ustekinumab ($258.8 m, $131.0 m) had the highest overall annual spending. Additionally, ustekinumab ($16,825, $15,576), guselkumab ($10,132, $9,543), and ixekizumab ($4,895, $4,673) had the highest AASPDU for both Medicare-D and Medicaid. Medicare-D and Medicaid spending for immunomodulators has grown substantially (319.9%) from 2012-2018 and is likely to continue to rise. Given this increase in federal spending and continued emergence of new immunomodulators, it is important to learn how we can counteract the trends and reduce future expenses for patients and our healthcare system.

Medicaid and Medicare Part B spending on immunomodulators and biosimilars.

INTRODUCTION: Prices for immunomodulators used in dermatological conditions are rising in the United States. While Medicare Part-D solely covers medication costs, Medicare Part-B covers outpatient infusion and injection costs given by medical professionals. We aim to analyze recent trends in Medicare Part-B spending on immunomodulators and their biosimilars used in the treatment of common chronic inflammatory dermatoses. METHODS: The 2012-2018 Medicare Part-B spending data on immunomodulators commonly used for dermatologic conditions were extracted from the Centers for Medicare and Medicaid Services database. Inflation was adjusted to reflect 2012-dollar amounts using the Consumer Price Index. RESULTS: Medicare Part-B spending has increased by 27.5% from 2012 to 2018 ($2.5B, $3.2B). Average annual total spending (AATS) is greatest for rituximab ($1,522,757,520), and average annual spending per maintenance dose (AASPMD) is greatest for ustekinumab-90 mg ($12,976). The percent change in AASPMD increased for all immunomodulators with Etanercept-50 mg having the greatest percent change (+64.6%, +$285.70). Infliximab had a greater AATS and AASPMD than its biosimilars. DISCUSSION: Medicare Part-B spending is often overlooked but plays a big role in federal healthcare spending. Exploring the strategic use of less expensive biosimilars could help mitigate spending.

Clinical Epidemiology and Management of Hidradenitis Suppurativa.

Hidradenitis suppurativa is a chronic immune-mediated inflammatory skin disease with a prevalence of 0.1-1%, characterized by nodules and abscesses in the axillae, groin, and inframammary areas, sometimes developing into tunnels (or fistulas) and scars. Because hidradenitis suppurativa is more common in women and in those aged 18-40 years, obstetrician-gynecologists (ob-gyns) have the opportunity to diagnose, educate, initiate treatment, and coordinate care with ancillary health care professionals. The recently published North American treatment guidelines, along with management information for patients with hidradenitis suppurativa who are pregnant or breastfeeding, are summarized. By diagnosing and optimizing hidradenitis suppurativa treatment early in the disease course, ob-gyns can reduce morbidity, with the potential to favorably alter disease trajectory.

Pearls for Managing Atopic Dermatitis in Patients With Low Socioeconomic Status.

Atopic dermatitis (AD) is a chronic inflammatory dermatosis presenting with inflamed and itchy skin. Recent studies have shown an inverse relationship between socioeconomic status and the severity of AD. Low socioeconomic status (LSES) individuals with AD face specific barriers that may impede management. These include forgoing doctor's appointments due to transportation costs, inability to take time off from work, and lack of affordable childcare services. Unaffordable medications and over-the-counter products for managing AD further present as significant challenges for LSES patients. This article aims to offer practical and affordable recommendations to help mitigate the challenges faced by LSES patients with AD and thereby alleviate disease burden and improve treatment outcomes.