Eingun James Song, MD: Improving Efficiency in Dermatology Offices

Eingun James Song, MD, continued his discussion with the HCPLive editorial team regarding useful tips for dermatologists, a topic covered in his presentation given at the 2023 Fall Clinical Dermatology Conference in Las Vegas.

Song both works as associate chief medical officer and director of clinical research for Frontier Dermatology in Washington.

“The next tip is don't reinvent the wheel,” Song said. “Chances are if you have a problem, someone else has had that same problem. And they probably already have a template or a standardized letter that you can use. So the examples that I come across are for patients who have conditions where the insurance companies may consider it cosmetic.”

Song explained that for conditions like alopecia areata or vitiligo, some payers will say this is cosmetic and that they are not going to approve it.

“For those instances, what I would do is go to the societies or the foundations that already have pre-written letters that you can just print out and auto-populate it and just submit them to the insurance companies to show them medical necessity,” he said. “Rather than coming up with your own, that's gonna save you a lot of time. The same is true for maybe off label usage of drugs like infliximab, for hydrating lettuce suppurativa. We know that's one of the most effective treatments for HS, but it is technically off label. So if you just go to the HS Foundation's website, you can find a prior authorization template that you can use.”

Song noted that this template may substantially simplify that approach.

“The next tip was knowing when to ‘back door,’” Song said. “So there's going to come a point where you've tried everything and it just doesn't work. The insurance company does not want to approve that drug. So and then you want to think outside of the box and know when you need to get maybe a little bit creative. So what I mean by that is certain instances of patients who might not have severe enough disease to get on a drug, let's say an atopic dermatitis patient, but their (body surface area) is too low. Then, you can maybe ask about other comorbid conditions that the drug is approved for.”

He used the examples of asthma and psoriasis to illustrate his point as well.

“If you have pretty limited psoriasis and the insurance company won't approve a biologic ask about psoriatic arthritis, hidradenitis suppurativa, inflammatory bowel disease,” Song said. “Those are all ways that we can sometimes kind of ‘backdoor it.’ And maybe the last example I would give is palmoplantar dermatitis. That's a very tough disease to treat. And what we've seen work really well in those patients are oral JAK inhibitors. But the only oral JAK inhibitors that are approved right now are going to be for psoriatic arthritis and atopic dermatitis, at least innate in dermatology.

Song added that unless these patients have psoriatic arthtitis or atopic dermatitis, clinicians would not be to be able to get that oral JAK inhibitor approved.

“And some people may not feel comfortable doing this, but technically if you biopsy someone who has palmoplantar dermatitis, it often comes back spongiotic and spongyosis probably is a type of eczema. So some people may consider coding this as atopic dermatitis, or eczema, to get it approved. Although understandably, not everyone feels comfortable doing that.”

The last tip Song provided from his presentation was to consider outsourcing.

“So what I mean by this is that there are a lot of companies out there, mostly specialty pharmacies, that want your business,” he explained. “They make money by getting these drugs approved. So finding or partnering with a specialty pharmacy that wants to do these prior authorizations for you could be a very good partnership, because they pretty much are acting like your virtual bio-coordinators. And as you know, bio-coordinators, they're expensive. Not everyone has the capability to hire a dedicated staff.”

Song also noted the possibility of using outpatient pharmacies which are known to get specialty pricing on certain medications.

“So what they'll do is they'll buy a drug for a discounted price, they'll bill the insurance to full price, and they get to keep that difference,” Song said. “And so these outpatient pharmacies, they really want your business as well. Because they're run by pharmacists, they can actually write the drug under their NPI code, not yours. So they can pretty much do everything for you. And we actually have one locally to us that we've worked with, really had a great working relationship.”

To learn more about the contents of Song’s conference talk, view the video posted above.

The quotes contained in this summary were edited for clarity.