The cost of topical immunomodulator therapy in Medicare patients varies by prescriber specialty.
BACKGROUND
Topical immunomodulators (TI)-including corticosteroids, calcineurin inhibitors, and vitamin D analogues-are commonly prescribed in multiple specialties, but cost comparisons are lacking.


OBJECTIVE
To evaluate differences in costs of TI across specialties and determine associated variables.


METHODS
A cross-sectional study was performed using the Centers for Medicare & Medicaid Services 2008 and 2010 Prescription Drug Public Use Profiles, which contain 100% of drug claims made by Medicare beneficiaries.


RESULTS
Branded drugs cost an average of $174.02 more than generics per 30-day supply (P < .001). Differences in health insurance benefit phase, drug choice, brand name, and coverage type were the greatest determinants of patient cost (P < .001). Prescriptions for low-, medium-, and high-potency TI from specialists (mostly dermatologists) cost more than those from family medicine, internal medicine, and psychiatry/neurology physicians; total costs of a 30-day supply from a specialist differed from family and internal medicine physicians by $7.36-$14.57, and patient costs were higher for specialists by $1.69-$3.16 (P < .01). Brand names were prescribed 8% of the time by specialists and 1.4%-3.1% by nonspecialists.


CONCLUSIONS
We were unable to adjust for some confounders of cost, such as medication weight or treated body area, and the data does not reflect previous treatment failures or use by non-Medicare patients.


CONCLUSIONS
The costs of TIs prescribed by specialists (primarily dermatologists) are higher than those prescribed by primary care physicians and could be reduced by choosing more generics within the respective potency classes.
Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Myron
M
Zhang
Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Jonathan I
JI
Silverberg
Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio. Electronic address: Benjamin.Kaffenberger@osumc.edu.
Benjamin H
BH
Kaffenberger
D000287:Administration, Topical; D003430:Cross-Sectional Studies; D003880:Dermatology / Q000706:statistics & numerical data*; D011307:Drug Prescriptions / Q000191:economics; D016568:Drugs, Generic / Q000191:economics / Q000627:therapeutic use; D005194:Family Practice / Q000706:statistics & numerical data*; D007155:Immunologic Factors / Q000008:administration & dosage / Q000191:economics*; D007388:Internal Medicine / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D009462:Neurology / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011306:Prescription Fees / Q000706:statistics & numerical data*; D011570:Psychiatry / Q000706:statistics & numerical data; D012871:Skin Diseases / Q000188:drug therapy; D013038:Specialization / Q000706:statistics & numerical data*; D014481:United States
D016568:Drugs, Generic; D007155:Immunologic Factors
Medicare; atopic dermatitis; cost of care; inflammatory skin disease; prescription drug costs; psoriasis; topical immunomodulators; topical steroids