What to Know Before the American Academy of Dermatology Meeting

Dermatologists are heading to San Diego this weekend for the annual American Academy of Dermatology meeting. It’ll be a packed event; last year’s conference drew more than 18,800 registrants and featured 380 educational sessions.

Unsure where to start? Want to know what to be on the lookout for? Unable to attend? Don’t worry, we’ve got you covered. We checked in with the Academy and some of the event’s attendees to find out what will be top of mind. And follow all the news coming out of the meeting using #aad18.

Drug costs are increasing and not just for new products. Many dermatologists have noticed that patients are grappling with higher drug costs than in the past. Some of the increase can be attributed to a number of newly-approved biologic drugs for conditions ranging from plaque psoriasis to melanoma. But those aren’t the only culprits. Topical and oral medications are also more expensive, even those that have been on the market for quite some time. And it’s raising concern about affordability and access.

“Over the last five years, the cost of dermatology drugs has skyrocketed, including many of our commonly used drugs that have been generic for decades,” said Dr. Erik Stratman, who chairs the Academy’s scientific assembly committee.

Dr. Hilary Baldwin, medical director of the Acne Treatment & Research Center in Morristown, N.J., says the price of generics has increased so rapidly that brand-name drugs are often the better value, not only in price but also because they’re more effective and cause less irritation.

“A drug that cost just $10 a few years ago can now cost $250 or $300,” she said. “I now go almost exclusively through specialty pharmacies. And I discourage patients from going through regular pharmacies.”

Insurance companies have also been pushing back on reimbursing products, often requiring prior authorization before paying for a product. For some physicians, that could mean 10 to 20 prior authorizations each week, at four to five pages long, said Dr. Michael Sherling, a dermatologist who is chief medical officer at Modernizing Medicine, which makes electronic health records and other software for physicians.

Drug manufacturers will offer rebates on brand-name products, but those initial cost savings can be deceiving, said Dr. Kevin Kia, who is part of a panel discussion on how to choose the most cost-effective options for diseases like lupus, leg ulcers and fungal infections.

“They’re very misleading,” Kia said about drug rebates. “They’re cheaper in the minute, but at the end of the year, that’s a huge amount that is then spent on brand name drugs. If you do that regularly, that raises costs across the board.”

But he acknowledged his colleagues’ frustration. “Historically we’ve written generics as a low-cost alternative,” he said. “It’s a really strange time where we can’t write generics and we can’t write brand.” Share your thoughts at #Dermdrugcosts

Related sessions:

Best Evidence Based Opportunities for Cost-Effective Skin Care: Friday, February 16; 9:00 AM - 12:00 PM

Controversies and Difficult Questions Concerning Biologic Therapeutics: Saturday, February 17; 9:00 AM - 12:00 PM

Value in Healthcare: Improving Outcomes and Decreasing Waste: Saturday, February 17; 3:30 PM - 5:30 PM

Dermatologists are feeling increasingly overwhelmed. When it comes to workplace happiness, dermatologists have typically scored higher than other specialists. But there’s a dark cloud on the horizon, and that’s the speed at which burnout is showing up among dermatologists. A 2016 study from the Mayo Clinic and American Medical Association found that dermatologists experienced the largest increase in burnout among the specialties surveyed. And the challenges contributing to the numbers are mounds of paperwork, the costs of implementing electronic health records and government regulations, the data show.

Burnout will be a topic of the Sunday morning plenary session with Dr. Abraham Verghese, a bestselling author who practices at Stanford, as well as a number of other sessions during the week.

It also factors into some of the live simulations during the meeting. In addition to surgical demonstrations, attendees will get the chance to work with mock-patients, or actors who simulate what it’s like when demanding or unhappy patients come into the exam room. #Dermburnout

Related sessions:

Bureaucracy, Compliance, and Burnout: What it Means to Dermatologists, Saturday, February 17; 4:30 PM - 5:30 PM

Battle the Burnout: Reignite the Flame! Sunday, February 18; 1:00 PM - 3:00 PM

Dermatologist Burnout: How to Spot it and How to Avoid it, Monday, February 19; 7:30 AM - 8:30 AM

Exciting new drugs are coming down the pipeline. One of the hottest topics at this year’s meeting will be on what’s in the pipeline for difficult psoriasis cases, according to the AAD. The disease is particularly challenging because only half of patients have a good response to current treatments, and that number falls off the longer patients are treated.  

“None of the drugs have fixed the situation adequately,” said Dr. Kim Papp, a dermatologist who is president of Probity Medical Research.

There are two-dozen drugs in late-stage development for psoriasis, according to National Psoriasis Foundation. Papp is an investigator on Sun Pharma’s tildrakizumab, one of the late-stage drugs in development that works by blocking interleukin-23, a pathway believed to be central to the development of psoriasis lesions. The company will present data from its Phase 3 reSURFACE trial in patients with moderate to severe psoriasis at the meeting.

Another session will walk through the research on whether cannabinoids have a role to play in inflammatory conditions like psoriasis, acne and eczema.

Dermatologists will also discuss the 2016 guidelines for treating acne, which urge doctors to look for ways to avoid antibiotics, because of the concerns about drug resistance. New drugs on the horizon include targeted antibiotics that have a narrower spectrum and less systemic absorption.

Baldwin is also presenting data from the Phase 4 OSCAR trial with Galderma’s Epiduo Forte, which will show that the gel not only reduces acne but also prevents scarring.

“We’ve talked for years about the psycho-social effects of acne … but we didn’t really look at the effect of having to continue on with scars,” she said. “The scars definitely affect how people perceive us.” #NewAADdrugs

Related sessions:

Psoriasis and Atopic Dermatitis: Advances in Therapy and Comorbidities, Friday, February 16; 9:00 AM - 11:00 AM

Scientific Studies Which Support the Topical Use of Hemp, CBD, and THC for Anti-aging, Psoriasis, Eczema, and Acne, Saturday, February 17; 7:30 AM - 8:30 AM

Acne and Rosacea, Saturday, February 17; 9:00 AM - 12:00 PM

The way doctors get paid has fundamentally shifted. Every specialty is feeling the pressure from new physician reimbursement guidelines that were drafted under the 2015 Medicare Access and CHIP Reauthorization Act, or what’s widely referred to as MACRA. At its core, MACRA changes the incentives for doctors so they’re paid based on the quality of care they provide rather than the volume of patients they see. But the change requires significant investments in how doctors track and report their performance to Medicare.

“Not only do you have to see a patient, but you have to document these six quality metrics that you pick,” Sherling said.

That’s a particular burden in dermatology, where most doctors still practice in small groups and are less able to absorb the immense cost.

“Over half of dermatologists are in private practice or single-specialty practice,” Stratman said. “The MACRA and MIPS [or Merit-based Incentive Payment System] requirements are really issues that small group and private private practices are wrestling with.”

The program will also include information on the Academy’s Dataderm initiative, which aims to bring big data to how dermatologists make treatment decisions. #Dermreimbursement

Related session:

The Future of Dermatology: What Changes are Coming and How Can We Prepare? Sunday, February 18; 1:00 PM - 3:00 PM