Primary care physicians prescribe fewer expensive combination medications than dermatologists for acne: A retrospective review.

BACKGROUND: Many dermatologic medications are available as expensive combination products, though their lower-cost, generic components are available. Underutilization of these cheaper replacements is common and influenced by several factors, including prescriber's knowledge and disease severity. OBJECTIVE: To characterize differences in prescribing patterns for high- vs lower-cost dermatologic agents for acne between dermatologists and primary care physicians (PCPs). METHODS: Using an administrative insurance claims database, IQVIA PharMetrics Plus for Academics, we identified medication claims between January 01, 2017, and June 30, 2022. Inclusion criteria were claims for high-cost medications and lower-cost alternatives for patients diagnosed with acne. We excluded patients without continuous insurance enrollment for the previous year. Data collected included patient, prescriber, and prescription characteristics. Distribution of costs to payers and patients were compared using the Wilcoxon rank sum test. RESULTS: We identified 7,843 patients with medication claims meeting inclusion and exclusion criteria. High- vs low-cost acne medications cost insurers a median $480.6 (IQR: 377.2-535.2) vs $81.8 (IQR: 30.3-162.3), respectively, whereas patient burden was $60.0 (IQR: 40.0-182.4) vs $15.0 (IQR: 10.0-35.4). Dermatologists prescribed the largest number of acne medications, 7,648 of 9,791 (78.1%), and a higher proportion of high-cost medications (7.8% vs 1.3% for PCPs, P < 0.001). Median insurer cost was lower among dermatologists ($86.9, IQR: 33.6-184.5) than PCPs ($87.3, IQR: 87.3, P = 0.008), but means were higher (mean ± SD: $144.3 ± 169.9 vs $119.5 ± 126.9, respectively). Median patient cost was higher for dermatologists ($20.0, IQR: 10.0-40.0) than PCPs ($15.0, IQR: 10.0-25.0, P < 0.001). The mean costs were similarly higher (mean ± SD: $49.8 ± 105.6 vs $34.0 ± 60.9, respectively). CONCLUSIONS: Dermatologists prescribed a higher percentage of high-cost medications for acne. These differences resulted in a slightly higher distribution of costs to the patient but lower for the insurer, as median is a better indicator of the cost distribution. System processes to identify high-cost combination medications and provide low-cost alternatives may further reduce costs.