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 That's because dermatologists and other specialists are three times
more likely than primary care providers to prescribe brand name
versions of drugs known as topical immunomodulators, which includes
treatments such as corticosteroids, calcineurin inhibitors and
vitamin D analogs, the study found.
For a 30-day supply, brand prescriptions were associated with about
$174 higher average total costs and roughly $27.00 more in average
out-of-pocket costs for patients than generic alternatives, the
study of Medicare claims also found.
"We would assume dermatologists are treating more extensive diseases
and thus requiring higher volumes of topical treatments but this was
not available in the database," said senior study author Dr.
Benjamin Kaffenberger of Ohio State University Medical Center in
Columbus.
"This data is not linked to outcomes or diagnoses," Kaffenberger
added by email. "It is possible that outcomes may justify the
additional costs in this study, for example, if they get the right
treatment that works for them and they don't need return visits."
To understand differences in costs and drug choices based on
physician specialty, researchers examined prescription data for
people with Medicare Part D drug benefits in 2008 and 2010. Costs
from 2008 were adjusted for inflation to 2010 prices.
The inflation-adjusted total cost of all topical immunomodulators
was $232 million in 2008 and $252 million in 2010, researchers
report in the Journal of the American Academy of Dermatology.
Overall, the average total cost for a 30-day supply of medicine was
$56.20 in 2008 and $51.90 in 2010.
Researchers also analyzed prescriptions from doctors in specialty
fields including dermatology, family medicine, internal medicine,
psychiatry and neurology.
Regardless of medication potency, prescriptions generally cost more
when patients saw dermatologists than when they received care from
other physicians, the study found.
For patients, out of pocket cost for a 30-day prescription from a
dermatologist was $13 to $14 higher than a prescription from a
physician in family or internal medicine and $23 more than one from
a specialist in psychiatry or neurology.
In comparison to doctors in family or internal medicine,
dermatologists prescribe drugs with a yearly cost of $30 million to
$32 million more, and $25 million to $27 million more for
prescriptions of similar potency, the authors calculate. This
suggests that there's a potential to save up to about 11 percent on
total costs using prescriptions from family and internal medicine
doctors, they conclude.
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One limitation of the study is that it only includes adults 65 and
older, which may mean the findings could be different for topical
treatments more commonly prescribed for children, the authors note.
The data also didn't specify that "specialists" were dermatologists,
even though that is usually the type of provider who will treat
patients with skin problems.
Another challenge in cost comparisons for topical treatments is that
people may use different amounts over different surface areas on the
body. This means that unlike pills, which can easily be calculated
into a daily cost, the amount patients use out of a single tube
varies, contributing to differences in cost from one person to the
next.
While not all brand-name remedies have generic alternatives on the
market, generic topical treatments can work just was well for the
vast majority of patients in most clinical situations, said Dr.
Aaron Kesselheim, a researcher at Brigham and Women's Hospital and
Harvard University in Boston who wasn't involved in the study.
"Patients should make sure to ask their physicians about whether
there is a less expensive generic drug that is indicated for their
conditions," Kesselheim added by email. "Cost-related nonadherence
is unfortunately too common among patients, and substitution of an
equally effective generic drug for a brand name drug is a simple way
to improve patient adherence and clinical outcomes."
SOURCE: http://bit.ly/2ktvhJS Journal of the American Academy of
Dermatology, online February 2, 2017.
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