 The pandemic has certainly amplified some of these hurdles for us. Something I noticed when the hammer dropped in March of last year was that we saw a massive push from payers to fax in requests for prior authorizations. They were really ramping up the nonmedical switching and giving us a very narrow window of time to respond before they went forward. I think they were taking advantage of the fact that they knew a lot of offices were closed, that the world was on fire, so to speak, and that people were out or being furloughed. I distinctly remember my medical assistants telling me about this and that they had never seen such an urgency on the payer side to address these things, and I think it was—granted, this is my own personal opinion; I don’t know for sure, but at least this is how I interpret it—that some were taking advantage of the situation. So that’s 1 problem. Even if that was not the case—because of social distancing, offices closing, and furloughing—even if it was the same old rigmarole, balls are being dropped, things are being missed because people are not there, people are not physically in the office. Calling in there should be limited access, so nonmedical switching and parallel patient hurdles certainly jumped through the roof and became much more efficient. That is not a good thing for the patient or for the practitioner.

In terms of the impact of nonmedical switching and how that translates to overall care, let’s start with having a visit. Initially we were, at least at GW [George Washington University School of Medicine and Health Sciences], predominantly doing telehealth, which can make it difficult in certain clinical scenarios to assess the theory of disease. I’m a huge proponent of telehealth; especially in a pandemic, it keeps people home and safe, and it allows them to get the care they need. Even outside of pandemic, it really overcomes some of the costs I mentioned when it comes to nonmedical switching: going in to see a doctor, having to take off work, getting dependent care, keeping someone at home or even at work. Certainly, if someone is flaring up or they are doing worse and you need to really see them firsthand—maybe some new adverse event is emerging that requires a biopsy, or you need to get blood work done because of it—we are limited, or at least more limited than before. Of course, with severe adverse events, patients need to be seen in the emergency department, which was initially flooded with patients with COVID-19. This is overwhelming the medical system if it is happening, and this puts these patients at risk for infection. Let’s think about who we are talking about here. We are talking about patients with chronic inflammatory diseases who are likely more at risk for poor outcomes when it comes to COVID-19 infections. Think about what is killing people. The virus is part of it, but it’s the inflammatory response, the cytokine storm, that is life-threatening. 

All these diseases I’ve been harping on—psoriasis, hidradenitis suppurativa—just want an excuse to set fire to the inflammatory storm, so to speak. These patients, and we know from some registry data, both inside and outside dermatology, are not controlled on systemic agents like biologics. They actually have the worst outcomes when it comes to COVID-19. Nonmedical switching could actually predispose a patient to worse outcomes if they were to get COVID-19, especially if their medication is not working. My opinion based on the data available to us is that in this current climate it is becoming harder to combat, but it also comes with even more baggage, given the new world we live in.

Nonmedical switching is just 1 of many ways payers get in the way of us doing what we do best and what we love to do, which is care for our patients. Those not involved in the care of our patients should not be making the be-all and end-all decisions regarding how these patients—most important our patients—are being managed. We could be part of the solution and not part of the problem. 

Passive observance makes you guilty of being part of the problem, so what can you do? Get involved with the American Academy of Dermatology (AAD). Get involved with the Alliance for Patient Access. Get involved with your local Dermatology Societies. There are so many ways you can be an advocate for your patients. You could be an advocate for your poor but absolutely incredible staff who work tirelessly to make sure your patients are getting cared for. You could also be an advocate for your colleagues, who are banging their heads against the wall when they get those letters from insurance companies that are telling them what they should be using for their patients even if it is not FDA approved, even if what they are proposing is a misinterpretation of a AAD Clinical Guideline that was published 10 years ago. We need to band together. Together we are strongest, and we will overcome this in a way that won’t burn us out. Rather, we will be victorious and once again help our patients and do the best job we possibly can.

Adam Friedman, MD, FAAD discusses how payors accelerated non-medical switching during COVID-19 and how healthcare providers can respond to new challenges. 

COVID-19 and Payor Strategies for Non-Medical Switching 

Adam Friedman, MD, FAAD, The George Washington School of Medicine & Health Sciences

Christina Y. Weng, MD, MBA, is a professor and the Alice R. McPherson Retina Research Foundation Chair in Ophthalmology at Baylor College of Medicine.

Implications of Gene Therapy in Retina, With Christina Y. Weng, MD

In a field marked by rapid innovation, gene therapy is emerging as one of the most promising advances in 

American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting

, Christina Y. Weng, MD, MBA, a professor and the Alice R. McPherson Retina Research Foundation Chair in Ophthalmology at Baylor College of Medicine, offered perspective on the transformative potential of these therapies and what they could mean for both patients and providers.

Weng outlined how these gene therapies have the potential to raise the bar for treatment durability to new levels, highlighting three key benefits these therapies could offer: more consistent dosing, fewer injections, and greater overall efficiency in disease management.

“The first one is that we know that most patients are under-treated with anti-VEGF in the real world, and consequently, they suffer from suboptimal visual outcomes,” Weng told 

. “By providing constant dosing of anti-VEGF, gene therapy might help counteract this challenge.”

Weng also emphasized the value of steady dosing, noting that current treatment methods center on bolus dosing, which often causes recurrent anatomic fluctuations and could negatively impact outcomes. Gene therapy could provide a steadier level of dosing, which could render benefits not yet fully realized, as well as lead to fewer burdensome injections.

“Those injections are not only associated with psychological burden, financial burden, but there's also substantial socioeconomic costs,” Weng told 

. “Many of these patients come in each time, bringing in an accompaniment or arranging transportation, etc. All those things can also be reduced with the reduced treatment burden that gene therapy might bring.”

As several gene therapy programs reach late-stage trials, Weng is closely watching the results to see if efficacy signals seen in earlier trials are replicated with larger cohorts. She cited the importance of safety, with reported issues like intraocular inflammation and pigmentary changes becoming important factors in regulatory and clinical decision-making.

“All of the programs I've mentioned have found their gene therapy candidates to be well tolerated, but many have also been associated with adverse events such as intraocular inflammation, pigmentary changes, and episcleritis,” Weng told 

. “The Phase 3 studies will provide important insights on safety, and they're also going to pressure test some of the prophylactic strategies being evaluated.

Looking ahead, Weng noted gene therapy could drive a paradigm shift in disease management,” particularly when paired with advances like home optical coherence tomography (OCT). However, questions remain about how these new options will fit into treatment algorithms.

“We’ve entered the era of gene therapy, not just for rare diseases, but also for some of our most common,” Weng told 

. “Several programs are in late stages, and those results will be key in providing safety and efficacy data that will determine the viability of these gene therapy candidates. If they do emerge on the market, they have the potential of significantly reducing treatment burden and potentially improving visual outcomes for our patients.”

Weng reports relevant disclosures with Alcon, AbbVie, Apellis, Astellas/Iveric Bio, Genentech, Regeneron, and others.

Weng CY. The Current State of Gene Therapy for Retinal Diseases. Presented at: 2025 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting. April 25-28, 2025. Los Angeles, CA.

Gene therapy could revolutionize retinal disease treatment, promising consistent dosing, fewer injections, and improved patient outcomes, as highlighted by expert Christina Y. Weng.

Christina Y. Weng, MD, MBA

In this video segment, Reau, Trivedi, and Hirschfield discuss recent shifts in treatment goals for patients with PBC and a new focus on timely intervention with second-line options.

Shifting Treatment Goals, Timelines in PBC

In recognition of the US Food and Drug Administration accelerated approval of Gilead's seladelpar (Livdelzi) and other recent evolutions in 

 Special Report spotlights a conversation between a trio of subject matter experts on the latest advancements in PBC and their implications for disease management.

A chronic and progressive autoimmune liver disease affecting intrahepatic bile ducts, common symptoms of PBC include ​​jaundice, pruritus, and fatigue. Ursodeoxycholic acid (UDCA) has long been the mainstay of treatment for PBC and continues to be the only first-line therapy. However, many patients do not respond to or are unable to tolerate UDCA, underscoring the need for more treatment options to prevent progression to cirrhosis and eventual liver failure as well as to improve symptoms most negatively impacting patients. In the past 3 months alone, the PBC treatment landscape has seen the addition of 2 new therapeutic options with the accelerated approvals of seladelpar and elafibranor, both of which are proliferator-activated receptor agonists shown to reduce alkaline phosphatase.

 Special Report on the evolving landscape of PBC management, moderator Nancy Reau, MD, asks Palak Trivedi, MD, PhD, and Gideon Hirschfield, PhD, MB BChir, about how treatment goals in PBC have evolved over time, to which Hirschfield describes how the historic view of PBC as a slow-progressing, chronic liver disease where the primary objective was to prevent liver failure or delay the need for transplantation has changed. Now, current approaches aim not only to prevent disease progression but also to normalize liver function tests and improve overall patient well-being.

Trivedi mentions the importance of timely intervention, noting that while historically it was acceptable to wait for gradual improvements in liver tests, the current focus is on achieving results within shorter timeframes—particularly for high-risk patients. This shift underscores the necessity of introducing second-line agents sooner if patients do not show significant improvement.

Check out the other segments in this series:

Assessing PBC Treatment Options, Sequencing

Considerations for Treatment Sequencing in PBC

Impact of Next-Generation PPAR Agonists on PBC Management

The Future of PBC Management, Pipeline Developments

: associate director of solid organ transplantation and section chief of hepatology at Rush University Medical Center

 associate professor and honorary consultant hepatologist and clinical research director for industry engagement at the University of Birmingham

 director of the Autoimmune Liver Disease Program at University Health Network’s Francis Family Liver Clinic and Toronto Centre for Liver Disease and Lily and Terry Horner Chair in Autoimmune Liver Disease Research at the University of Toronto

Shifting Treatment Goals, Timelines in Primary Biliary Cholangitis

Gideon Hirschfield, PhD, MB BChir

 reduces the frequency of emergency department visits.

“Our main outcome that we're most excited about was that we reduce the use of the emergency room or hospital by half in the intervention group compared to the usual care,” lead investigator Greg A. Sachs, MD, from Regenstrief Institute, told 

Sachs and colleagues conducted IN-PEACE (Indiana Palliative Excellence in Alzheimer Care Efforts), a randomized clinical trial assessing palliative care for neuropsychiatric symptoms among community-dwelling patients with moderate-to-severe dementia. Secondary outcomes included Symptom Management in End-of-Life Dementia scores, caregiver depression scores (via Patient Health Questionnaire-8), caregiver distress scores (NPI-Q distress), and combined emergency department and hospitalization events. Primary and secondary outcomes were assessed quarterly for 24 months, with the 2-year follow-up completed either by January 7, 2023, or death.

Patients with moderate to severe dementia and their caregivers were recruited between March 2019 and December 2020 from 2 cites in central Indiana, totaling 201 dyads. The mean age of patients was 83.6 years; 67.7% were female and 43.3% were African American.

Neuropsychiatric Inventory severity scores for patients receiving palliative care did not significantly change from baseline to 24 months (9.92 vs 9.15) compared with those receiving usual care (9.41 vs 9.39) (between-group difference at 24 months, -0.24; 95% confidence interval [CI], -2.33 to 1.84; 

The trial failed to meet its primary endpoint, with patients receiving insignificant improvement of neuropsychiatric symptoms through 24 months for individuals receiving palliative care for dementia compared with usual care.

“We were surprised that [palliative care] didn't have a bigger impact on symptoms, especially since some of the interventions we were using had previously been shown to reduce neuropsychiatric symptoms, such as agitation or psychotic features,” Sachs said.

Although these findings did surprise Sachs and his team, he reflected that this could be because patients already had low levels of neuropsychiatric symptoms at baseline. The neuropsychiatric levels stayed relatively low for both patients receiving palliative and usual care.

“We may have been attracting into our study people who were already doing relatively well with respect to some of the symptoms,” Sachs said.

The finding that palliative care for dementia cuts emergency department visits was particularly exciting for Sachs and colleagues. The study took place during the COVID-19 pandemic when people with dementia were getting hospitalized at a high rate, with a high mortality. Despite this, they were still able to reduce visits to the emergency department.

“[The findings] support the notion that we should be trying to do palliative care upstream from hospice, rather than waiting until the last weeks or months of life in hospice, which, by the way, is very difficult to prognosticate in patients with dementia, we're not very accurate figuring out when somebody's sort of within that 6-month zone,” Sachs said. “If we can have both palliative care specialists and primary care, incorporating more of this approach into ongoing care over the last few years of life, we think that it could provide the greatest benefit to patients and families.”

Disclosures for Sachs include Nova Nordisk Inc.

Sachs GA, Johnson NM, Gao S, Torke AM, Hickman SE, Pemberton A, Vrobel A, Pan M, West J, Kroenke K. Palliative Care Program for Community-Dwelling Individuals With Dementia and Caregivers: The IN-PEACE Randomized Clinical Trial. JAMA. 2025 Jan 29. doi: 10.1001/jama.2024.25845. Epub ahead of print. PMID: 39878993.

Derman, C. Palliative Care for Dementia Cuts Emergency Department Visits, Hospitalizations. HCPLive. January 30, 2025. 

https://www.hcplive.com/view/palliative-care-dementia-cuts-emergency-department-visits-hospitalizations

HCPLive spoke with Sachs about his study on palliative care for dementia, which reduced ED visits but didn’t significantly improve neuropsychiatric symptoms.

Palliative Care for Dementia Cuts Emergency Department Visits, with Greg A. Sachs, MD

Greg A. Sachs, MD 

Harold E. Bays, MD, FOMA, FTOS, FACC, FNLA, FASPC

Janelle Ball is the founder/CEO of and a biologic coordinator consultant at BC Educators LLC. She is also a consultant for Bristol Myers Squibb and speaks for Amgen, UCB, Janssen, Sanofi, Regeneron, and AbbVie.

SDPA Annual Summer Dermatology Conference

 in Washington, DC, featured a session at the meeting titled ‘Professional Development Track: Navigating Insurance Authorizations,’ hosted by Janelle Ball.

Janelle Ball is known for her prior work in the field of dermatology as well as her role as founder, CEO, and biologic coordinator consultant for BC Educators LLC. Ball was interviewed by the 

 editorial team on-site at the SDPA meeting, and she was first asked about which common challenges she sees in 

 practices when it comes to prior authorizations, along with ways clinicians and PAs can avoid them.

Discussing Strategies for Insurance Authorization Success, with Janelle Ball

“The biggest challenge is just not having a process set up, and not having everybody working on the prior authorizations,” Ball explained. “You know, if everybody doesn't understand how to get a prior authorization, or just knowing how to educate patients, those are some of the biggest challenges…If you're having multiple hands in the pot, it slows the process down a lot. So if you have a dedicated person who can help manage and streamline the workflow, it can help make sure patients get on medications a lot faster, providing them with resources and a point of contact.”

Ball was also asked a variety of other questions regarding achieving success with regard to insurance authorizations in the field of dermatology. She emphasized the importance of patient-centered communication in her talk, and was asked what this looks like in the context of insurance delays and about ways practices can keep patients informed without overwhelming them.

“I think the biggest thing is just keeping them in the loop,” Ball said. “Let them know as soon as something gets denied, but also let them know that just because it's denied doesn't mean it's the end of the road, making sure that they understand what the next steps are. If you know a denial happens, if there's a bridge program or a patient assistance program, [figure out] how they're going to be able to get their medication. Really educate them on the cost. Those are some of the biggest factors for patients not starting a therapy, where they don't understand the cost and they don't understand the support that's available.”

For any additional information on Ball’s insights on this topic, view her full interview segment posted above. To find out more about this and other news in the dermatology space, view our 

The quotes used in this interview summary were edited for the purposes of clarity.

This interview at SDPA features Janelle Ball, founder and CEO of BC Educators, who discusses tips related to success with insurance authorizations.

Janelle Ball

Jonathan Stine, MD, MSc, is an associate professor of medicine and public health science and director of the Fatty Liver Program at Penn State University.

Developing a Multidisciplinary Care Model for MASLD, with Jonathan Stine, MD, MSc

New research is calling attention to the potential utility of a novel multidisciplinary care model for adult patients with 

metabolic dysfunction-associated steatotic liver disease (MASLD)

Historically, MASLD treatment relied solely on lifestyle changes, including diet, exercise, and weight loss. The treatment landscape underwent a hisotrical development in March 2024, when the US Food and Drug Administration (FDA) granted accelerated approval to Madrigal Pharmaceuticals’ resmetirom (Rezdiffra) for the treatment of noncirrhotic 

metabolic dysfunction-associated steatohepatitis (MASH)

 with moderate to advanced fibrosis, making it the first and only FDA-approved pharmacologic treatment option for the progressive liver disease.

Despite the availability of a pharmacologic treatment option for patients, lifestyle interventions continue to play a pivotal role in their care. Because MASLD is a multisystem metabolic disorder affecting much more than just the liver, its treatment is complex and requires attention from multiple specialties.

Although multidisciplinary MASLD care has been endorsed by leading hepatology societies, it has not been widely implemented in clinical practice, largely due to a lack of standardization.

“We saw several important areas to improve upon models that already existed, and our goal was [to create] this one stop shop for all patients,” Jonathan Stine, MD, MSc, an associate professor of medicine and public health science and director of the Fatty Liver Program at Penn State University, explained to 

Some of the key elements to this improved care model include the colocation of specialists in the same clinic to allow patients to move through a structured sequence of visits with multiple providers all in the same clinical space and the inclusion of a standardized lifestyle assessment and intervention, including counseling on diet, exercise, sleep hygiene, alcohol, and smoking cessation.

Additionally, the model integrates pharmacologic management for patients who may benefit from resmetirom, GLP-1 RAs, or clinical trials and provides individualized, coordinated management for each patient with their entire care team.

“This model is the most comprehensive one out there that I've seen,” Stine said. “many existing programs lack key specialists such as exercise physiologists or obesity medicine experts. By providing these key health care providers, we've been able to enhance the effectiveness of lifestyle intervention when paired with drug therapy, and then ultimately improve some of the medical outcomes shown in the primary paper.”

Between October 2023 and August 2024, 78 consecutive adults were enrolled in the multidisciplinary care model, 26 of whom had data available at 6 months. In these patients, several improvements in liver health and metabolic health were observed. Specifically, investigators noted 39% achieved a clinically meaningful reduction in ALT and 79% achieved A1c <7%.

Additionally, 72% of patients achieved LDL <100 mg/dL, including 69% of patients with diabetes. Results also showed 50% achieved SBP ≤130 mm Hg; 35% achieved guideline-based amounts of weekly physical activity; and 26% achieved body weight loss of ≥5%.

“If we can demonstrate that multidisciplinary care improves outcomes while also being cost effective, I really believe this will become the new standard for MASLD management,” Stine said.

Editors’ note: Stine has relevant disclosures with Astra Zeneca, Galectin, Kowa, Noom Inc., Novo Nordisk, and Zydus Therapeutics.

Brooks A. Multidisciplinary Care Model Improves Liver, Metabolic Outcomes in MASH. February 20, 2025. Accessed February 27, 2025. 

https://www.hcplive.com/view/multidisciplinary-care-model-improves-liver-metabolic-outcomes-mash

Stine explains key components of a new multidisciplinary MASLD care model and how it improves upon preexisting models.

Jonathan Stine, MD, MSc

Advances in Managing Recurrent C Diff Infection, with Paul Feuerstadt, MD

 has long posed a major clinical challenge, with few effective, durable treatment options and until recently no FDA-approved microbiota-based therapies.

For decades, management revolved around antibiotic courses that often failed to prevent recurrence—leaving patients caught in a debilitating cycle and providers with limited tools. The FDA approval of fecal microbiota, live-jslm (Rebyota) signalled a major shift in the trajectory of C. diff treatment.

 is recurrence,” Paul Feuerstadt, MD, a clinical gastroenterologist and an associate clinical professor of medicine at Yale University School of Medicine/PACT-Gastroenterology Center, explained to 

, noting that an estimated 35% of individuals treated with guideline-based treatments will recur.

He goes on to describe how antibiotics only treat part of the infection and do not fully resolve the underlying microbial imbalance. When it comes to addressing recurrence, Feuerstadt references historical approaches with microbiota restoration therapy or fecal microbiota transplant and, more recently, the FDA approval of fecal microbiota, live-jslm.

New data presented at Digestive Disease Week (DDW) 2025 highlight findings from 5 pooled trials of live-jslm, showing a consistent favorable safety profile with similar rates of treatment-emergent adverse events (TEAEs) reported in all live-jslm recipients (70.9%), 1-dose recipients (67.6%), and placebo recipients (60.2%). Most TEAEs were mild or moderate in severity, gastrointestinal in nature, and related to C. diff recurrence and/or preexisting conditions, with few events (<1%) being considered possibly related to live-jslm.

In a second abstract at DDW, Feuerstadt and colleagues explored the safety and clinical effectiveness of live-jslm when administered by colonoscopy. Physician experiences with the 41 procedures included in the study were largely positive, with 90% of investigators reporting at least a ‘positive’ or ‘very positive’ experience across all aspects of administration. Additionally, material preparation time and ease of passage through the colonoscope were mentioned as reasons for ‘positive’ or ‘very positive’ experiences.

Of note, among the 39 participants who completed 8-week visits, all (100%) were assessed as either having ‘much improved’ or ‘very much improved’ CGI-I.

“As we're starting to evolve these FDA approved treatments, RBL is diversifying its data, showing that across 5 trials, including 3 phase 2 trials and 2 phase 3 trials, it's incredibly safe,” said Feuerstadt. “When we apply this knowledge to putting the material through a colonoscope, [we see] that is also safe and effective and a potential modality that can be broadly used.”

Editors’ note: Relevant disclosures for Feuerstadt include Rebiotix Inc, Takeda Pharmaceuticals, Ferring Pharmaceuticals, Seres Therapeutics, and Probiotech.

Khanna S, Awad T, Guthmueller B, et al. PHYSICIAN EXPERIENCES AND USABILITY OF FECAL MICROBIOTA, LIVE-JSLM (RBL) ADMINISTERED VIA COLONOSCOPY TO ADULTS WITH RECURRENT CLOSTRIDIOIDES DIFFICILE INFECTION: ANALYSIS OF A PHASE 3B STUDY. Abstract presented at Digestive Disease Week (DDW) 2025 in San Diego, CA from May 3 - May 6, 2025.

Lee C, Feuerstadt P, Louie T, et al. SAFETY OF FECAL MICROBIOTA, LIVE-JSLM, IN ADULTS WITH RECURRENT CLOSTRIDIOIDES DIFFICILE INFECTION: AN INTEGRATED SAFETY ANALYSIS FROM 5 PROSPECTIVE CLINICAL TRIALS. Abstract presented at Digestive Disease Week (DDW) 2025 in San Diego, CA from May 3 - May 6, 2025.

Feuerstadt explains recent advances in treating recurrent C diff and reviews new data on the safety and administration of fecal microbiota, live-jslm (Rebyota).

Paul Feuerstadt, MD

Protecting Cardiorenal Function in Diabetic Kidney Disease

1:27 Diabetes, kidney disease, and CV risk interrelationship

3:54 Expanding indications for SGLT2 inhibitors for CV risk reduction

5:40 CV benefits of SGLT2 inhibitors in clinical trials

9:20 Using stage and severity of CKD to guide treatment choice

14:00 Benefits of combining finerenone with SGLT2 inhibitors

16:30 Potential use of GLP 1 agonists for CKD

19:20 Considerations for incorporating therapies for CKD

23:00 Key takeaways on using new treatments for CKD

Dhiren Patel, PharmD, and Bob Busch, MD, interview Fatima Cody Stanford, MD, MPH, MPA, an obesity medicine specialist, to examine the cardiovascular (CV) impact of obesity and delve into the potential benefits of newer weight loss medications in mitigating CV risk and heart failure.

Protecting Cardiorenal Function In Diabetic Kidney Disease

Robert Busch, MD

Experts conclude this series highlighting what is on the horizon of retinal disease care. 

Perspectives on the Future of Retinal Disease Management

In this final segment, the participants share their excitement for the future of retina care this year and beyond. Across the panel, experts express enthusiasm for the constant evolution of therapies, techniques, and technologies in the field of retina. They touch on the ongoing trials and current research, acknowledging the challenges and complexities of developing new drugs but remains optimistic about potential breakthroughs. Experts circle back to gene therapy, emphasizing the potential for game-changing developments once challenges like inflammation are addressed. The physicians across the panel are excited at the prospect of higher durability agents to continue improving patient quality of life.

This summary was AI-generated and edited for clarity.

Authors