Make Some Noise: Advocating for Access

Adam Friedman, MD, FAAD, is an associate professor of dermatology in the department of dermatology at George Washington School of Medicine and Health Sciences in Washington, DC, where he also serves as the Residency Program Director and the Director of Translational Research. In addition, Dr. Friedman is a member of the medical advisory board for the Derma Care Access Network (DCAN), where he is helping to turn up the volume on important access to care issues in dermatology.

What is the Derma Care Access Network (DCAN)?

Adam Friedman, MD: DCAN is a project of the Alliance for Patient Access that is dedicated to addressing issues related to access to therapies and clinical care in dermatology. We are a group of stakeholders including patients, patient advocates, physicians, and scientists, and together we are sponsoring educational initiatives and advocacy programs to encourage informed policymaking about the benefits of access to approved therapies and appropriate clinical care.

What are some of the bigger access to care issues in dermatology?

Dr. Friedman: A big issue, and thus major focus of DCAN, is access to medicine for dermatologic conditions. Acne affects 50 million people, 18 million adults have atopic dermatitis, and close to eight million people have psoriasis. These are common, chronic problems with well-documented horrible effects on quality of life. Why should access to medication be an added element of stress for our patients? Unfortunately, it is. Step-up therapy requires that patients try numerous treatments before being covered for medications that will likely be more effective such as biologics in psoriasis or isotretinoin for acne.

The prior authorization process is another roadblock, with an often-disconnected insurer saying, “I don’t think the patient needs this medication, but if you do, you can phone us, write a letter, or fill out a form to change our minds.” This process can take weeks and all the while there is no medication for the patient. Moreover, the company may still say no even after an arduous appeal process.

So, what is the solution?

Dr. Friedman: Showing outcomes. We need to demonstrate that it is cheaper to disease modify early on than when all comorbidities and harm set in.

What is DCAN doing to make this a reality?

Dr. Friedman: We are working to recruit a critical mass of physicians and advocates to boost our advocacy efforts. Education is another DCAN goal. We have a digestible consumer-facing video on YouTube, which helps patients understand the prior approval process. Most patients have no idea what the process is, and our aim is educate them about the problem. A white paper, called Overcoming Barriers to Dermatological Treatment, is aimed at physicians, advocates, and policymakers. These are two components of our educational initiative. Everyone learns differently so we are running the gamut of delivery with our messaging including social media, print, and digital outreach to get information out there.

Anything else in the works?

Dr. Friedman: I want DCAN to come to dermatology meetings and show attendees what we are all about to get even more people involved. Many organizations are already on board including the American College of Allergy, Asthma, and Immunology, American Autoimmune Related Disease Association, the Asthma and Allergy Foundation of America, the Dermatology Nurses’ Association, the International Hyperhidrosis Society, the National Alopecia Areata Foundation, the National Eczema Association, and the Society of Dermatology Physician Assistants.