How do you combat this waste of time? It’s not as if these prior authorizations are aimed at responsible cost containment or better patient care. We can have an honest debate about the place for Yervoy and Zelboraf for metastatic melanoma, but you can’t debate the place for Elidel and Protopic for chronic eczema on the face. If a company wants to exclude commonly used, relatively inexpensive medications, then they should be forced to reveal exactly who is giving them advice on dermatologic formularies. If the advice runs counter to the universally accepted standards for practice within our specialty, then that dermatologist should be compelled to explain his or her reasoning. I suspect that, in many cases, there is no dermatologist, but that is what transparency and accountability are all about. Exposing insurance companies and third-party pharmacy managers that are misleading us and our patients is an important mission for the future.
There is only one thing I am sure about: It is a waste of time for us to fight these battles one patient at a time. It’s time for big fights with big players to fix this problem in a comprehensive manner.
Dr. Goldberg is a dermatologist in private practice in White Plains and Bronxville, N.Y. He has been a member of the Skin & Allergy News editorial advisory board since 1995, and he has no financial conflicts to disclose.