Casey Butrus, PharmD: [Dr Mostaghimi], I know multidisciplinary care is crucial to the successful management of patients. How do you think physicians, managed care pharmacists, and payers can work together to make sure appropriate medications are getting to the patients?

Arash Mostaghimi, MD, MPH, FAAD: I just spoke about transparency between a physician and a patient. This is what to expect, this is what the process looks like, etc. One thing that would be tremendously useful is…I’ll give you this analogy. I can go anywhere in the United States and pull out Google Maps or Waze, somewhere I’ve never been. They can tell me the cost of gas in every gas station around me, how far it is, and where to go to. And gas is changing 10 times a day, [and as] the cost changes they’re able to keep up with that. So as you mentioned, [Dr Butrus], there are times in which absolutely bizarrely a medication that I might think is much more expensive [is] actually the first line and would be covered in a moment. Whereas I’ve had, for example, a clindamycin lotion that may need prior authorization, [while] a combination benzoyl peroxide clindamycin may go through with no problem. And that has to do with whatever negotiations the payer has done with regard to what access they have. Sometimes a branded product is cheaper than even the generic medication. And as an academic practice, we take every single type of insurance. We literally take every insurance in Massachusetts except for one, which is our rival insurance, and we would never take it. But it is something like 60 different plans, and then within those, there’s different pharmaceutical benefits, etc. So it’s not even that you can teach me and then I know what to do for one patient or the other. It should be incorporated in a real-time manner into the prescribing habits where I can go on the computer and it says, here are the exact agents, here is exactly how much it will cost. And it’s a little bit technically hard to do. It requires integration with the EHR [electronic health records], but it would reduce the prior authorization time for me or reduce the prior authorization time for you guys. And it would allow us to say to some patients, hey, this is $10 or this is $20, and for some patients that $20 is too much. So we could tell them exactly how much it costs and how much they’re going to get for that. And if it’s a tretinoin, for example, maybe it’s $50 but it lasts for 3 to 4 months, that’s different. You can tell them the quantity and all those types of things. So this is my dream...I think even better integrated, more thoughtful prior authorization techniques would be [good]; can we just know what the game is that we’re playing before we’re getting there? And if everybody knew the rules, I think we [would] get to the end much faster and everybody would benefit.

Casey Butrus, PharmD: I agree. I think transparency is definitely something that we have in mind and try to aim for. I know a lot of health plans still use fax prior authorization. So there’s definitely a work in progress transitioning to electronic prior authorizations and using technology. But I know other health plans have started to adopt real-time authorization so you know at the time of prescribing what medications are on the formulary. If they’re not on the formulary, what alternatives would be on the formulary that we would require to try first, or even having the prior authorization criteria in front of you at the time? As you mentioned, every health plan manages things differently; some may prefer one brand, and some may not prefer another brand. So if every health plan was able to get on board and do that, I think that would be the ideal situation. I think it’s just getting the technology up-to-date and hoping that some innovative health plans can start breaking the barriers in this space too and making it the new norm.

Transcript edited for clarity.