Controversies: Drug costs, non-physician providers discussed

Audience members of Friday's “Controversies in Dermatology” weigh in on the discussion about PAs and NPs.

Audience members of Friday’s “Controversies in Dermatology” weigh in on the discussion about PAs and NPs.

Several speakers debated the impact of medications and mid-level providers on costs during Friday’s “Controversies in Dermatology” (F046).

Mark Lebwohl, MD, and Charles W. Stiefel presented “Cost of Medications Is Outrageous.” William Abramovits, MD, and Mark S. Nestor, MD, PhD, presented “PAs and NPs Are Overused.” Raymond L. Cornelison Jr., MD, of OKC Dermatology Associates, Oklahoma City, was the director of the session.

“We all went into this to make patients better, and a lot of our colleagues in the pharmaceutical industry did too,” said Dr. Lebwohl, the Sol and Clara Kest Professor and chairman of the department of dermatology at the Icahn School of Medicine at Mount Sinai Hospital, New York.

Drug costs

Dr. Lebwohl expressed concern about rebates to pharmacy benefit managers, step therapy practices, and prior authorizations. He said the size of rebates is going up. Adding to physician and patient consternation is that health plans seeking to manage medications typically focus more on rheumatology and dermatology than other specialties. This is evident in the way they set controls through step therapy and prior authorizations.

Stiefel, a pharmaceutical industry expert, discussed the impact of generic drugs.

“To get approved by the FDA, a generic only has to prove that it’s bioequivalent to the brand. Generic drugs rely on the brand’s dossier to get approval,” Stiefel said. “As a result, it’s much cheaper and quicker to get a generic drug approved, and it costs almost nothing to market. Consequently, brand sales typically decrease more than 90 percent a few months after a generic is approved.”

PAs and NPs

In his remarks, Dr. Abramovits noted that NPs and PAs undergo far less education and training than physicians. Yet, a shortage of more than 90,000 physicians is expected by 2020, while 30,000 NPs train each year.

The best solution is to provide training and make sure you don’t put NPs and PAs in situations where they treat patients without proper instructions, Dr. Abramovits said.

Dr. Nester showed how a care team approach has helped overcome manpower issues in his office, which employs four PAs and two medical assistants. Such an approach can increase care and efficiency, make physicians more efficient, and improve office patient contact times, he said.

“They can never be the dermatologist. They can be our hands, eyes, and ears to some degree and the vehicle to maximize our time,” said Dr. Nester, director of the Center for Cosmetic Enhancement at the Center for Clinical and Cosmetic Research, Aventura, Florida. “Dermatologists can flourish, if they learn to maximize their practices. Our patients want to be treated by this care team approach. I think mid-level providers can be an integral part of this team and make dermatology better for the future.”

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