Casey Butrus, PharmD: Dr Cameron, it seems like you have some familiarity with prescribing topical ruxolitinib. How do you go through the prescription process and the prior authorization process of getting that prescription to the pharmacy? Do you go more the retail pharmacy route or specialty pharmacy route?

Michael Cameron, MD, FAAD: I think that’s a great question. I think for Opzelura [ruxolitinib], we suspect that we’re going to encounter prior authorization, as we do for most of our medications now, particularly our brand medications in dermatology. But we’re willing to get through that as best we can because we know it’ll really make an impact on our patients’ lives. It’s just such a great therapy, and so I think there’s some incorrect perception on Opzelura [ruxolitinib] being a biologic, so to speak.

First of all, people in general call JAK inhibitors biologics all the time, but they’re not biologics. They’re small molecules, but even with that, these are topicals, so you do not need to send this necessarily to an Optum Rx or an Express Scripts and have it mailed to the patient. You can send this to any retail pharmacy, and I’ve certainly had success getting this covered at a Duane Reade or a CVS, or a Walgreens pharmacy. I will say in my practice we’ve chosen to use, and I believe you have as well, Dr Keegan, a local dermatology-focused pharmacy that provides white-glove service, that helps coordinate the PA [physician assistant] process with us, and interfaces well with our electronic medical record, and then does a free parcel delivery. I live in Manhattan, so they bike the medication to the patient and they drop it off. So I think that that’s been a real value for our patients, and they work on getting it covered.

Brian Keegan, MD, PhD: They’ve been in New Jersey for probably 10 or 12 years, and we get free delivery in New Jersey as well.

Michael Cameron, MD, FAAD: There you go.

Brian Keegan, MD, PhD: There you go, but it’s been an uptake for those. Initially, when they came out, there was some patient resistance in my office. Maybe there was a perception that I somehow had some vested interest in this pharmacy or there was concern about sharing their credit card information with this unknown entity, etc. But over the years I’ve seen that there’s been greater uptake as patients realize that there are certain pharmacies that are willing to do a bit more than others are in order to earn their business, and that’s been very helpful for those patients and with certain subsets of medications.

Amy Brennan: I think that’s a key component of this patient experience. It is opening their eyes to the fact that they don’t necessarily have to use the normal local pharmacies that they’re familiar with, that there are other options for them that are still local and are still that same service, but like you said, white glove. A little bit more hands-on and helping to drive that process because, as you said, almost everything at this point in dermatology requires prior authorization, even the topical corticosteroids, so for us, requiring prior authorization is nothing out of the ordinary. That is the new norm for dermatology, so to have especially a local pharmacy specialized in dermatology that understands the landscape and understands that prior authorization process and helps you to get through it rapidly is good, because the point is for the patient to fill as quickly as possible for the lowest co-pay possible is how I’ve always looked at this market.

So it’s having that local pharmacy automatically start that prior authorization process for the office and send it over, and have us pick it up, send it to the insurance payer, prove how they’re meeting the criteria, and get them approved. On top of that, and I know we’ll discuss this later, but there are resources like co-pay cards, so those pharmacies locally are able to add co-pay cards on top of their regular commercial insurance coverage, which can ease the burden of access for those patients.

Brian Keegan, MD, PhD: When you said the phrase “patient experience,” I think it rung another chime in my head because, as Dr Cameron has said before and you’re alluding to, this is a chronic condition, so if a patient has a really challenging experience on visit No. 1, we can try to help to reassure them that now that it’s gotten approved, things should be smoother. But if they have a difficult experience on field number 2 and it’s a burden to think about doing this month after month to continue to get your medications and say, “I have to spend X amount of time on the phone with somebody,”we’re all very busy.

They don’t have that kind of time, so patients may be willing once to work on it hard, but they need to have a good patient experience in terms of getting their medicines, or they’re not going to continue treatment. If they don’t continue treatment, they flare up and they end up back in our office and say things like, “It just didn’t work,” and sometimes “it didn’t work” means that “it didn’t work, because I couldn’t keep getting it.” Not because the medicine didn’t work. The process didn’t work.

Casey Butrus, PharmD: I like how you all brought up the open distribution modality of obtaining mainly all the atopic dermatitis medications from a pharmacy, whereas some biologics are maybe only required to be filled at a specialty pharmacy. Topical Opzelura [ruxolitinib] can really be filled at any pharmacy, whether it be retail or a boutique pharmacy, and I think just for Opzelura [ruxolitinib] specifically, having the cost be over $830 per month, which is currently what CMS [Centers for Medicare & Medicaid Services] defines as a specialty tier, maybe a specialty tier on some formularies. I think understanding that specialty tier doesn’t always mean a specialty pharmacy is required to fill it, even though the patient may have that higher cost-sharing because of the co-pay.

Transcript edited for clarity.