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Dr. Song spoke in this segment of his interview on several more insightful elements from his presentation titled ‘Early Dermatology Practice Pearls.’
This interview segment with HCPLive featured Eingun James Song, MD, providing more tips for dermatologists that had been featured in his presentation at the 2023 Fall Clinical Dermatology Conference in Las Vegas.
Song serves as the associate chief medical officer and as the director of clinical research at Frontier Dermatology.
“The third tip here is knowing when to, kind of, pick your battles,” Song explained. “I will just say starting off early in my career, I used to fight the insurance company on every single drug that didn't get approved if it wasn't my preferred drug. So I would do the appeals, the peer to peers. And after a while, I'm like, ‘Look, I just don't have the time and I don't have the bandwidth to fight them on every single medication.’ So it's knowing when it is okay to accept the alternative medication that the insurance company is suggesting?”
Song compared this to the alternative, during which one might put a foot down and not accept the alternative.
“While I'm doing that, I'm going to put them on an assistance program, we call it a bridge program,” he said. “If I had a moderate-to-severe plaque psoriasis patient that's never been on a biologic before and they have no contraindications, I'm gonna just prescribe whichever biologic I could get approved. Quite frankly, they all work pretty well.”
In these situations, Song explained that there is no concern which interleukin (IL)-23 inhibitor is approved or which IL-17 inhibitor is approved, as long as a drug is accessible.
“Compare that to a patient, let's say that has plaque psoriasis, that's already failed a TNF-inhibitor,” Song said. “Now I want maybe an IL-23 or an IL-17 inhibitor, if that insurance company is going to require me to put them on yet another TNF-inhibitor, which we know in those patients who didn't respond to one, the likelihood of responding to another one is much lower. That to me is not a medical decision. That's the case where I'm going to actually fight the insurance company and I'm going to put them on a bridge program.”
Another tip Song elaborated on was knowing the step therapy.
“A lot of our advanced therapies, and they require you to try some other, quite frankly, cheaper and less effective therapies first, before you could get the newer and probably the better therapy,” he said. “So knowing what those step therapies are, that can really help streamline your process. This is going to be a little bit different across the different regions. I'm in the Pacific Northwest, which historically has been the most restrictive as far as access. So you know, we probably have it the worst versus the South or the East Coast in which it generally seems to be a little bit more open as far as a formularies.”
He added that explaining that certain medicines may need to be tried out first is important because that is what some insurance companies require.
“Maybe the last example I'll share here is that we have several new topical branded products,” he said. “For both atopic dermatitis and psoriasis, most of them are going to require a what we call a dual-step edit. So as topical steroids, a topical calcineurin inhibitor or a vitamin D, so again, I'm going to make sure I prescribe both of those medications even before I think I'm gonna prescribe a branded topical.”
For more information from Song’s conference talk, view the video posted above.
The quotes used in this summary were edited for the purposes of clarity.