The last few years have seen the development of fabulously effective treatments for psoriasis and other skin conditions. We can expect even more major developments in dermatologic therapeutics. The speed at which these developments are occurring seems to be accelerating. We now have many options and can pick and choose treatments to best meet our patients’ needs. Well, at least we can in theory.
In this issue, my friend, international psoriasis expert Dr Larry Green has written a terrific article on how managed care is making it harder for patients to get the best medication for their condition (See page 21). He describes the growing impediments and hurdles that we and our patients face, the hassles and the paperwork, and how we got here, with our strange system of negotiated prices, rebates, copayment assistant cards, and utilization management controls. He also describes the important work he, the National Psoriasis Foundation, and the American Academy of Dermatology are doing to help ease our burden and to reduce the hurdles insurers can place on us.
Another side to managed care exists, however. While we are all focused on the prior authorization hassles that seem to question our good judgment, patients’ insurers—including managed care—pays for the care patients need nearly all the time. We focus on the squeaks in the wheel and not the fact that, for the most part, medical care is rolling along pretty well. It upsets us that it is so difficult for patients to get the medication we feel is best, but we do not count our blessings that even if we cannot get our patients access to the treatment we feel is best, we can get coverage of treatments that are still very, very good—extraordinarily better than what was the gold standard treatment just a few years ago.
Health insurance has been fabulous for us and our patients. It has spoiled us into thinking that patients have a right to the absolute best possible care (a wonderful right in theory; a dubious right in practice). The availability of so much money funneled into health care by health insurance has also created the incentives to create the modern miracle drugs that we now use to change our patients’ lives in fundamental ways and the even better medications that are coming. Those same health insurance structures that have given us and our patients such better lives have increased the cost of care, and, without doubt, have led to the need for someone to take some responsibility for controlling costs and rationing health care in America.
I do not want to be responsible for rationing my patients’ care. Like Dr Green, I simply want to give patients the best possible care. In reality, I settle for being able to provide patients the best care I can possibly give them within the constraints imposed by our health system. I greatly appreciate the efforts of Dr Green and those like him who are working and fighting to make our health system be the best we can make it.
Steven R. Feldman, MD, PhD
Chief Medical Editor
Dr Feldman is with the Center for Dermatology Research and the Departments of Dermatology, Pathology, and Public Health Sciences at Wake Forest University School of Medicine in Winston-Salem, NC.
The last few years have seen the development of fabulously effective treatments for psoriasis and other skin conditions. We can expect even more major developments in dermatologic therapeutics. The speed at which these developments are occurring seems to be accelerating. We now have many options and can pick and choose treatments to best meet our patients’ needs. Well, at least we can in theory.
In this issue, my friend, international psoriasis expert Dr Larry Green has written a terrific article on how managed care is making it harder for patients to get the best medication for their condition (See page 21). He describes the growing impediments and hurdles that we and our patients face, the hassles and the paperwork, and how we got here, with our strange system of negotiated prices, rebates, copayment assistant cards, and utilization management controls. He also describes the important work he, the National Psoriasis Foundation, and the American Academy of Dermatology are doing to help ease our burden and to reduce the hurdles insurers can place on us.
Another side to managed care exists, however. While we are all focused on the prior authorization hassles that seem to question our good judgment, patients’ insurers—including managed care—pays for the care patients need nearly all the time. We focus on the squeaks in the wheel and not the fact that, for the most part, medical care is rolling along pretty well. It upsets us that it is so difficult for patients to get the medication we feel is best, but we do not count our blessings that even if we cannot get our patients access to the treatment we feel is best, we can get coverage of treatments that are still very, very good—extraordinarily better than what was the gold standard treatment just a few years ago.
Health insurance has been fabulous for us and our patients. It has spoiled us into thinking that patients have a right to the absolute best possible care (a wonderful right in theory; a dubious right in practice). The availability of so much money funneled into health care by health insurance has also created the incentives to create the modern miracle drugs that we now use to change our patients’ lives in fundamental ways and the even better medications that are coming. Those same health insurance structures that have given us and our patients such better lives have increased the cost of care, and, without doubt, have led to the need for someone to take some responsibility for controlling costs and rationing health care in America.
I do not want to be responsible for rationing my patients’ care. Like Dr Green, I simply want to give patients the best possible care. In reality, I settle for being able to provide patients the best care I can possibly give them within the constraints imposed by our health system. I greatly appreciate the efforts of Dr Green and those like him who are working and fighting to make our health system be the best we can make it.
Steven R. Feldman, MD, PhD
Chief Medical Editor
Dr Feldman is with the Center for Dermatology Research and the Departments of Dermatology, Pathology, and Public Health Sciences at Wake Forest University School of Medicine in Winston-Salem, NC.
The last few years have seen the development of fabulously effective treatments for psoriasis and other skin conditions. We can expect even more major developments in dermatologic therapeutics. The speed at which these developments are occurring seems to be accelerating. We now have many options and can pick and choose treatments to best meet our patients’ needs. Well, at least we can in theory.
In this issue, my friend, international psoriasis expert Dr Larry Green has written a terrific article on how managed care is making it harder for patients to get the best medication for their condition (See page 21). He describes the growing impediments and hurdles that we and our patients face, the hassles and the paperwork, and how we got here, with our strange system of negotiated prices, rebates, copayment assistant cards, and utilization management controls. He also describes the important work he, the National Psoriasis Foundation, and the American Academy of Dermatology are doing to help ease our burden and to reduce the hurdles insurers can place on us.
Another side to managed care exists, however. While we are all focused on the prior authorization hassles that seem to question our good judgment, patients’ insurers—including managed care—pays for the care patients need nearly all the time. We focus on the squeaks in the wheel and not the fact that, for the most part, medical care is rolling along pretty well. It upsets us that it is so difficult for patients to get the medication we feel is best, but we do not count our blessings that even if we cannot get our patients access to the treatment we feel is best, we can get coverage of treatments that are still very, very good—extraordinarily better than what was the gold standard treatment just a few years ago.
Health insurance has been fabulous for us and our patients. It has spoiled us into thinking that patients have a right to the absolute best possible care (a wonderful right in theory; a dubious right in practice). The availability of so much money funneled into health care by health insurance has also created the incentives to create the modern miracle drugs that we now use to change our patients’ lives in fundamental ways and the even better medications that are coming. Those same health insurance structures that have given us and our patients such better lives have increased the cost of care, and, without doubt, have led to the need for someone to take some responsibility for controlling costs and rationing health care in America.
I do not want to be responsible for rationing my patients’ care. Like Dr Green, I simply want to give patients the best possible care. In reality, I settle for being able to provide patients the best care I can possibly give them within the constraints imposed by our health system. I greatly appreciate the efforts of Dr Green and those like him who are working and fighting to make our health system be the best we can make it.
Steven R. Feldman, MD, PhD
Chief Medical Editor
Dr Feldman is with the Center for Dermatology Research and the Departments of Dermatology, Pathology, and Public Health Sciences at Wake Forest University School of Medicine in Winston-Salem, NC.
