Soaring Drug Prices Put Physicians, Patients On Alert

Afflicted with numerous skin cancers and pre-cancerous growths, the elderly man had seen his SSDP dermatologist for years. When she diagnosed a new skin cancer on his face, a shocking reality came to light: the price of the topical chemotherapy cream his doctor had prescribed had skyrocketed out of reach.

"When the patient went to his pharmacy, he found the cream cost something like $500 or $600 out-of-pocket for him - and that's not including what his insurance would pay," explains SSDP Board certified dermatologist Viraj Shroff-Mehta, MD. The frequently-used treatment formerly cost the patient just $10 or $20 per tube. 

Steep and sometimes, sudden rises in medication prices have left some patients and physicians reeling. In June 2016, The Boston Globe reported that drug costs have become the fastest-growing component of health spending in the state, according to the Massachusetts Health Policy Commission. A July/August 2015 article in AARP Bulletin confirms the trend, and notes that even the prices of generic drugs that have been around for years - medicines that typically cost a penny a pill to make - have suddenly spiked. Medications such as the widely-used antibiotic, doxycycline, have climbed from $20 for 500 tablets to $1,849 in seven months, while the price of other acne and rosacea medications has increased by nearly 200%. The price of commonly-used topical corticosteroids used to treat psoriasis, eczema and other skin inflammations has increased by nearly 300% between 2009 and 2015. 

We think of ourselves as advocates for our patients and we try to be very cost-conscious... If the treatment is unaffordable, the patient isn't going to use it. SSDP dermatologist Viraj Shroff-Mehta, MD

The reasons behind today's rapidly rising drug prices are complex and impact all areas of medicine. For dermatologists and their patients, the changes have been particularly dramatic. "Drug pricing is skyrocketing and it is affecting dermatology more than any other specialty," observes former American Academy of Dermatology (AAD) President Mark Lebwohl, MD. A February 2016 article in the journal, JAMA Dermatology, reported brand price increases ranging from 180% for psoriasis medications to 1,240% for the topical medications used to treat actinic keratosis, basal cell carcinoma, HPV, molluscum contagiosum, and other common skin problems. The most pronounced changes occurred in the years since 2011, when prices quadrupled for seven out of the 19 drugs in the investigation.

At SSDP, the impact of rising drug prices affects both patients and physicians. Patients wonder why their dermatologists are prescribing, "such expensive medications," says Dr. Shroff-Mehta, while the SSDP dermatologists are scrutinizing every option before writing a prescription. 

"We think of ourselves as advocates for our patients and we try to be very cost-conscious," explains Dr. Shroff-Mehta. Generic drugs and more affordable options are the first treatment choice, whenever possible. If a particular medication turns out to be unaffordable for the patient, SSDP nurses may be asked to follow up with local pharmacies to find a less expensive alternative. Patients themselves are also encouraged to check their insurance plan's online drug formulary for a better-priced option. 

"All of this takes a lot of hours, manpower and duplication of effort because it makes things so much more difficult for even simple prescriptions. But if the treatment is unaffordable, the patient isn't going to use it," Dr. Shroff-Mehta observes. 

The rising price of drugs and its impact on patients has drawn the attention of the American Medical Association (AMA), which launched the interactive advocacy website, in 2016. Dr. Shroff-Mehta suggests visiting the site to learn about the causes of the recent rises in medication pricing and express concerns about the issue to members of Congress. The website may also help with comparison pricing for specific drugs. 

As for Dr. Shroff-Mehta's skin cancer patient who found the prescribed topical treatment was beyond his means, he turned to surgical removal of the growth, but then, changed his mind. Six months later, he had not undergone treatment for the cancer and the lesion was still on his face. 

"With six dermatologists in the group, we hear stories like this every day," Dr. Shroff-Mehta says. "For patients whose skin cancers can be treated with a cream, I don't think it's in anyone's interest to go for surgery or radiation. It's one thing if the patient fails the most benign treatment and needs another option. But for your doctor to start by recommending her second, third or fifth choice because her first choice is unaffordable just doesn't feel great." 

Learn more about the rising cost of medication in dermatology and other specialties and how you can get involved in advocating for change by visiting: 
The American Academy of Dermatology