Prescription patterns and costs of acne/rosacea medications in Medicare patients vary by prescriber specialty

Abstract

Background Prescription patterns for acne/rosacea medications have not been described in the Medicare population, and comparisons across specialties are lacking. Objective To describe the medications used for treating acne/rosacea in the Medicare population and evaluate differences in costs between specialties. Methods A cross-sectional study was performed of the Centers for Medicare & Medicaid Services 2008/2010 Prescription Drug Profiles, containing 100% of Medicare Part D claims. Results Topical antibiotics accounted for 63% of all prescriptions. Patients >65 years utilized more oral tetracycline-class antibiotics (TCA) and less topical retinoids. Specialist brand name usage for the most common topical retinoids and antibiotics was higher than family/internal medicine (FM/IM) by 6–7%. Topical retinoids by specialists were, on average, $18–20 and $2–3 more in total- and patient-cost than FM/IM per 30-day supply. Specialists and IM (60/56%) prescribed over twice the rate of branded doxycycline than FM (27%). TCA total/patient costs were higher for specialists ($18/$4) and IM ($3/$1) than FM. Limitations The data may contain rare prescriptions used for conditions other than acne/rosacea, and suppression algorithms may underestimate the number of specialist brand name prescriptions. Conclusion Costs of specialist prescriptions for acne/rosacea are higher than primary care prescriptions and could be reduced by choosing generic and less expensive options.

Ocular Rosacea microBiome Study (ORBS). Sub-microbial versus antibiotic dosing of doxycycline versus placebo in treatment of symptomatic ocular rosacea: study protocol for a parallel-arm randomized clinical trial

“…16,21 Curiously, long-term low dosing of doxycycline for ocular rosacea appears to be the universally accepted practice as this strategy is believed to bypass antimicrobial resistance, but investigation into conformation of this fact with more sophisticated genomic tools is lacking. [2][3][4] We note that antibiotic susceptibility determined by culture-based techniques may not fully represent the resistance pro le. 22 Growing phenotypically resistant cultures in petri dishes only reveals the bacterial pro le grown in culture, not the complete colonization and/ or infection of a patients' sampled system.…”

“…3 The most commonly used systemic treatment for rosacea is the bacteriostatic antibiotic doxycycline. 3,4 Rosacea treatment regimens of doxycycline vary widely. 6 Treatment-dose doxycycline for systemic infections is 200 mg a day.…”

Comparison of dermatologists and family physicians in terms of prescribing antibiotics for the treatment of acne vulgaris

“…FPs are known to prescribe antibiotics at the highest rate compared to other specialties. 9 However, when all the prescriptions are taken into account, antibiotics prescribed by FPs for skin diseases constitute 8% of the total. 10 FPs were found to prescribe systemic antibiotics to 33-37% of AV patients during initial examination, rising to 43% at repeated examinations within 90 days.…”

“…FPs are known to prescribe antibiotics at the highest rate compared to other specialties 9 . However, when all the prescriptions are taken into account, antibiotics prescribed by FPs for skin diseases constitute 8% of the total 10 .…”

Acne Protection: Measures & Miseries

“…Zhang et.al, 2017 revealed that higher brand-name usage and a broader range of topical steroids prescribed by specialists than primary care, which were associated with increased costs. The most common drug class utilized was topical antibiotics, accounting for 63% of all prescriptions [77]. Acne affects a large proportion of the Canadian population and has psychosocial and financial consequences.…”