Health Plans Rely on TCSs, TCIs for Atopic Dermatitis

From RADAR on Drug Benefits

Topical treatment Eucrisa (crisaborole), from Pfizer Inc., and biologic Dupixent (dupilumab), from Sanofi and Regeneron Pharmaceuticals, Inc., provide new options for the treatment of atopic dermatitis (AD), but most plans still rely heavily on generic topical corticosteroids (TCSs) and topical calcineurin inhibitors (TCIs).

TCSs and TCIs are first-line therapies, with Eucrisa and phototherapy approved if the first-line therapies fail. Most plans subject monoclonal antibody biologic Dupixent, with an annual wholesale acquisition cost of $37,000, to utilization management and won't approve it unless the other options don't work for that patient.

Beckie Fenrick, Pharm.D., senior partner-consulting, RemedyOne, suggests that "plans and PBMs will continue to prefer generic treatment options for this therapy area."

The American Academy of Dermatology guidelines of care for atopic dermatitis prefer the use of TCSs, TCIs and emollients as first-line therapy, according to April Kunze, Pharm.D., senior director, clinical formulary development and trend management strategy at Prime Therapeutics LLC.

Most plans prefer topical corticosteroids, Kunze says, with multiple generic topical corticosteroid products available in a wide range of strengths. TCI coverage is more variable — some plans allow them, and some require step therapy first, she says.

Dupixent, the first biologic approved for the treatment of moderate to severe atopic dermatitis, adds another class of agent to prescribe if the other classes fail, Kunze says. Yet not everyone who used Dupixent in clinical trials responded.

There are multiple biologics in phase two or three testing for atopic dermatitis, including tralokinumab from AstraZeneca plc and lebrikizumab from Dermira, Inc., both IL-13 specific monoclonal antibodies that originally were developed to treat asthma.

Still, there's no silver biologic bullet for atopic dermatitis yet.

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