Specialty dermatologicals spend grows 168 percent in 5 years

In recent years, we’ve seen rapid growth in the number of dermatologicals coming to market. Specialty dermatological drugs offer new hope to people who are living with certain skin conditions, which are becoming more common, and whose symptoms don’t respond well to other treatments – though these drugs come at a high cost to both members and plan sponsors.

Rising prevalence of skin conditions and the launch of novel therapies are driving higher utilization of dermatological drugs.^1,2 Since 2017, Caremark clients have seen a 150 percent increase in utilization of specialty drugs in the dermatological category to treat atopic dermatitis (AD), psoriasis, and psoriatic arthritis – and a corresponding 168 percent increase in spend per member per month (PMPM) for these drugs.³

These conditions affect millions of people in the United States.^5,6 While specialty drugs typically aren’t first-line treatments, they are aggressively marketed directly to consumers. As new dermatologicals enter the market, it’s crucial to have a framework in place for ensuring access to the right treatments to the right patients at the right time.

Notable dermatologicals that have recently come to market

Drug pipeline activity in the dermatologicals category doesn’t seem to be slowing down. Through proactive surveillance of the drug pipeline, we are able to anticipate new medications, as well as new formulations and indications for dermatologicals that are already available, to help Caremark clients plan ahead for how they’ll manage access and cost.

What’s ahead and developments expected

We’re keeping an eye on drugs currently under review that likely will get approval within the coming year. Lebrikizumab is one example. This new drug may treat AD in some patients with less frequent doses than current therapies, which could be more convenient and easier to manage. Patients may need just one subcutaneous injection every four weeks, whereas adults with AD may need doses of Dupixent every two weeks, though dosing varies based on age and indication.

We also anticipate expanded indications for drugs like Dupixent, which recently was approved to treat adults with prurigo nodularis (PN). This chronic condition causes hard, extremely itchy bumps on the skin. Dupixent is the first FDA-approved treatment for PN, which affects about 87,000 adults per year.¹³

Plan sponsors who want to deliver value to their members will need to be increasingly nimble in anticipating new therapies and having utilization strategies ready.

An integrated approach to managing access and spend

Fortunately, there are multiple approaches and combinations of strategies that can help control spend, including formulary design and utilization management. With the launch of biosimilar drug options in the specialty drug space, this will allow good formulary management to help lower overall costs. Specialty Guideline Management (SGM) and Enhanced SGM can help ensure specialty prescriptions align with FDA labeling, clinical guidelines, and evidence-based standards of care. Our comprehensive Dermatological Management Program bundles utilization management strategies specifically targeted at trend-driving dermatological conditions.

Virtual specialty care, such as Virtual Psoriasis Care, is another option. It can connect members who may not have access to specialists with providers who are better equipped to treat specific dermatology diagnoses than primary care providers. Virtual specialists can work with members to develop appropriate treatment regimens – and make adjustments as necessary – to support appropriate drug utilization along with most cost-effective treatment option.

These and other strategies can be part of an integrated approach that delivers both access and value to your population.