Video Blog: Roadblock: Challenges of Obtaining a Biologic/Small Molecule Drug

In this video blog, Michael Hewitt, MD, discusses highlights from his lecture, Roadblock: Challenges of Obtaining a Biologic/Small Molecule Drug, on July 27, 2024, during the inaugural Elevate-Derm Alliance Summer Conference at the Westin Copley Place in Boston, Massachusetts.

In this video

Dr. Hewitt notes that roughly a quarter of dermatology providers in the U.S. are prescribing, monitoring, and managing 100% of the biologics and small molecules across certain disease states — meaning patients in some geographies can't access "the latest and greatest." He points to why providers hold back: cost burden, lack of exposure during training, fear of these drugs' novelty, the staffing needed to handle approvals, and a preference for "bread and butter dermatology" over more complicated patients.

He walks through the biggest roadblocks — formularies set by PBMs, sorting out bridge therapy versus copay cards versus patient assistance programs, and building relationships with specialty pharmacies. Those specialty pharmacies, he says, act as a liaison between prescriber, bio-coordinator, and PBM; they stock and correctly transport the drugs, write letters of medical necessity, and get medication to patients quickly. His overarching philosophy: "where there's a will, there's a way," and he refuses to let formulary roadblocks undo the intimate, hard-earned decision made with a patient in the exam room — though he acknowledges the story is harder for Medicare, Medicaid, and VA patients.

• About a quarter of U.S. dermatology providers manage nearly all the biologics and small molecules — leaving patients in some areas without access to newer therapies.
• Providers avoid these drugs for reasons including cost burden, lack of training exposure, fear of novelty, and reluctance to take on more complicated patients.
• Key roadblocks are PBM-controlled formularies, navigating bridge programs versus copay cards versus patient assistance, and needing specialty pharmacies rather than a local chain.
• Specialty pharmacies stock and transport these drugs correctly, write letters of medical necessity, assist with prior auths, and serve as a liaison to speed medication to the patient.
• A strong bio-coordinator and office-to-office, peer-to-peer relationships are essential; "where there's a will, there's a way" for commercially insured patients, though access remains harder for Medicare, Medicaid, and VA patients.