In this special edition of Physician Spotlight, Mark D. Kaufmann, MD, FAAD an Associate Clinical Professor of Dermatology in the Department of Dermatology at the Icahn School of Medicine at Mount Sinai in New York City and Incoming President-Elect of the American Academy of Dermatology, and Neal Bhatia, MD, FAAD, Director of Clinical Dermatology at Therapeutics Clinical Research in San Diego and Chief Medical Editor of Practical Dermatology® magazine, discuss how the pharmaceutical industry can, and should, better serve dermatologists, patients, and the market.

What is the biggest pain point dermatologists have with pharma today?

Mark Kaufmann, MD: Drug access and pricing—which are often intertwined—are the most common hurdles we face.

Neal Bhatia, MD: As small derm-centric pharma companies slowly become extinct or become consolidated puzzle pieces of big pharma, the most painful part for dermatologists, aside from the cost and access issues, is the difficulty in establishing working relationships. The turnover of names and faces, as well as the loss of contact with long-standing members of the dermatology fraternity, makes the opportunity to collaborate more challenging. At many levels, from the American Academy of Dermatology to local dermatology societies, working with big pharma to gain interest and support for medical education has become very difficult with all of the firewalls and issues that are fundamental to big pharma.

In the days when pharma was dedicated to dermatology, the executives and leaders of the companies would not only be visible at meetings but very interactive and known by face and name. Big pharma with little connection to dermatology, compared to other companies that have hired dermatology veterans to sales, professional relations, and medical affairs, seem to be behind in this initiation to understanding how the dermatology family operates. I, for one, am constantly entertained by the Buzzword Bingo and script that big pharma fosters, and I can always tell when anyone has seen the light about how dermatology doesn’t follow the script. Hopefully as we move ahead from the pandemic, big pharma will be less concerned with customers and make more effort to cultivate partners in dermatology.

How do these pain points affect patient care?

Dr. Kaufmann: Patient care is impacted by delay in treatment and often having to have the patient use an inferior medication to “prove” that s/he really needed the medication you originally prescribed.

Dr. Bhatia: On the one hand, big pharma’s dedication to access programs, direct-to-consumer messaging, and sponsorship of patient advocacy initiatives have all given promising hope to patients for treatment awareness and options they might not have had in the past, especially in the biologics market. On the other hand, sample programs and patient support initiatives for dermatology are slowly gaining traction in clinics.

Are there any solutions being advanced?

Dr. Kaufmann: The only real solution is Pharmacy Benefit Manager (PBM) Transparency. In addition, advocacy against step therapies and prior authorizations should continue to be pushed.

Dr. Bhatia: I agree. We need a Sunshine Act for PBMs and a way to expose their role in pushing up the prices of therapies.

How can derm and industry work together to minimize and/or eliminate barriers that patients face in accessing their medication?

Dr. Kaufmann: The solution requires that all stakeholders—patients, physicians, and pharma—expose PBMs for what they are: organized crime! Only through this grass roots effort will we impose transparency on the pharmaceutical supply chain.

Dr. Bhatia: Industry and dermatologists need to collaborate to get out of the shadows of being the bad guys and expose the pharmacists and PBMs as the real manipulators of the system.

What else can dermatologists do to move the needle on these matters?

Dr. Kaufmann: We have to educate each other, as well as our patients, to shout that, “We’re mad as hell, and we’re not going to take it anymore!”