Casey Butrus, PharmD: Amy, I’m wondering, what other tools—you mentioned co-pay cards—-do you use the help patients who may be struggling with the prior authorization process? Or even if they do have approval, they still have a high co-pay, so how do you lower that cost share for them and make sure that they can afford their medication, so they start taking the medication?

Amy Brennan: I think resources are a huge part of this process. We need resources for us in the office to educate us and know where to go and how to go about getting that medication approved. But then once it’s approved, you’re right, that that’s really the first step. Now the biggest burden of the journey is the patient filling their drug, staying on therapy, and continuing to be able to access it based on affordability. So that’s where manufacturer co-pay cards come in huge. I think patient assistance programs, foundations, and things like that are a big thing. Tiering exceptions—different kinds of requests that you can do with insurance companies, not just a part of authorization requests, but also cost-exception requests or tiering exception requests to try to get those co-pays lowered for those patients—are great tools.

Casey Butrus, PharmD: What experience do you have when working with these patients? What role do they have in making sure their own success is played out with this prior authorization process?

Amy Brennan: I think that every patient is different. Some are really good advocates for themselves, and others need a lot of hand-holding. I think that’s why we try to meet them where they are. I have lots of patients who are proactive, and a lot of these manufacturers will have the resources, and they’ll have educators as well. So nurses within those manufacturers of the medications will proactively reach out to the patient and provide them education and help them with this journey in this pathway.

For some of the co-pay cards, the patient needs to activate them themselves; they need to fill out some paperwork. So that’s a burden of access, but that’s where we come in, and some of those even local specialized pharmacies can come in to help the patient understand what their role is in this process and what paperwork they need to fill out and how they need to advocate for themselves sometimes.

Brian Keegan, MD, PhD: Jumping on that, some scenarios that I’ve run into on the way sometimes may sound a little quirky to some of us, but I’ve had some patients who are apprehensive about using their insurance, there’s a fear that maybe it’s like car insurance, and if I get in an accident, my rates are going to go up. There are patients who say, “Don’t prescribe me an expensive medicine, I’m afraid that next year, my insurance rates will go up” and that it somehow changes their insurability. And, either A, I’m naïve, and I think that’s not true, or B, they misunderstand the system of insurance and how it works. Again, those are things that they may or may not vocalize when they’re with us in the office, and they can be, ultimately, barriers or burdens for the patients in terms of getting better because they don’t know how it might affect them.

Casey Butrus, PharmD: And I know with not using insurance or even with using a co-pay card, if some members have deductibles that they have to meet, they’re not contributing toward that deductible, and when they reached their out-of-pocket maximum and the doughnut hole, then it’s going to be a large sticker shock. So we always try to encourage, if they have insurance and it’s good insurance, to utilize the insurance and premiums that they’re paying for. That way, when they do potentially need that catastrophic coverage, they’re covered from that perspective.

Michael Cameron, MD, FAAD: I will say also, just to add on to that, the manufacturers of the oral JAK inhibitors, for example, have done a good job with support for laboratory JAK inhibitors as a lot of these newer drugs require significant lab monitoring. And we’re having more and more of these kinds of patients directed to high-deductible plans. That can be quite burdensome to patients, so it’s good to see that the manufacturers are trying to support patients [and that] there are programs for that.

Transcript edited for clarity.