(96) Navigating Specialty Treatment for Dermatologic Inflammatory Conditions: Patient Journey and Treatment Persistence

Background: : Step therapy requirements are often used to reduce prescription spending, yet the clinical utility and ultimate therapy outcomes for patients required to complete step therapy are largely unreported.

Objective: : Evaluate medication changes and clinical outcomes in patients required to use step therapy after being prescribed a specialty medication for psoriasis (PsO) or atopic dermatitis (AD).

Methods: : A single-center, retrospective review was conducted. Included patients had a referral for a specialty medication by a dermatology provider for PsO or AD that was discontinued because of step therapy requirements from January 2021 to June 2022. Outcomes included the number of patients that failed step therapy and were referred back for specialty therapy in all patients and the number of patients who were persistent (defined as still filling) at 12 months after initiating step therapy in patients who started specialty medication after a second referral. Data were analyzed using descriptive statistics.

Results: : Included patients (N=62) were predominantly White (73%) and female (58%) with a median age of 50 years (interquartile range [IQR]=37-60 years). 68% of patients had an indication of AD. 37 (60%) patients had a second referral and started a specialty medication after failing step therapy requirements. Post-initiation, 73% (N=27/37) were persistent, 11% (N=4/37) were lost to follow-up, 8% (N=3/37) switched to another specialty medication, 3% (1/37) discontinued due to developing an allergy to the specialty medication, 3% (N=1/37) discontinued due to experiencing a side effect, and 3% (N=1/37) discontinued for unknown reasons. Two patients switched due to experiencing side effects and one patient switched due to insurance requirements.

Conclusions: : Most patients required to complete non-specialty step therapy ultimately initiated specialty medications and were persistent on therapy 12 months after initiation. Step therapy requirements have the potential to delay clinically appropriate and effective treatment for AD and PsO.

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