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WDS Reception & Panel Discussion at Maui Derm

On January 29, 2018, on behalf of the Women’s Dermatologic Society, Dr. Lenore Kakita, Past President; Dr. Mary Maloney, Current President; and Dr. Julia Baltz, Resident Representative were asked to facilitate a discussion at the 14th Annual Maui Derm Meeting entitled, “The Future of Dermatology or its Demise.”  Included on the panel were Dr. Barbara Gilchrest of Harvard Medical School, Dr. James Leyden of the University of Pennsylvania, Victor Bulto Vice President of Novartis Immunology and Dermatology, and Robert Bitterman, Sr. CEO of Cutanea Life Sciences.  What ensued was a lively discussion of technology in Dermatology, patient access to a growing arsenal of medications, and the resultant rise in healthcare costs. 

Dr. Maloney started the evening by inviting panelists to give their opinion on patients’ increased access to their healthcare record.  Mr. Bulto of Novartis was quick to point out that there is an at times discordant balance of power between the various stakeholders of health, including the patient, the provider, and the payer, but that ultimately increasing patient engagement leads to better patient outcomes.  Similarly Dr. Gilchrest and Dr. Baltz agreed that increased patient engagement is inevitable and it behooves providers to educate their patients on the ways in which to use this technology to effect positive change on both the micro level of individual patient care and on a macro level in developing systems based models that integrate technology.

When discussing the Electronic Medical Record panelists readily admitted to frustration with a disruption of meaningful patient-provider interactions and the immense amount of after-hours work that falls on the physician.  Despite these frustrations, panelists agreed that in time the EMR could provide useful information for medical innovation through the collection of Big Data. 

Similarly the group felt that teledermatology and increased access to diagnostic technology are additional high impact inevitabilities in our specialty. Drs. Leyden, Gilchrest, and Maloney cited increasing evidence on the ways in which technology can improve access to care and diagnostic accuracy.

Specialty pharmacies and the high cost of biologic medications were topics of particular interest and concern to panelists and audience members alike.  Mr. Bitterman provided an excellent overview of the reasons that a pharmaceutical company may choose to contract with specialty pharmacies preferentially over chain drugstores.  Notably, specialty pharmacies allow for agreed upon pricing of medications, thus standardizing the reimbursement to the company and the amount paid by a patient.  In contrast, chain drug stores have a greater ability to substitute the prescribed drug with a generic or therapeutic equivalent in order to maximize profitability. Pharmacy Benefit Managers (PBM) are instrumental in setting the formulary for various healthcare plans.  PBMs are incentivized to put more expensive medications on formulary, as this leads to higher percentage based rebates from drug manufactures to PBMs.  The group concluded on the need for better transparency at every level of the drug delivery system.

In answer to the closing question on medication pricing, Mr. Bulto and Mr. Bitterman elucidated to the group the ways in which drug prices are decided.  The multifactorial metrics of drug pricing include societal value of a drug, geographic variations on cost of living and access, as well as the investment of research and development in the setting of an increasingly saturated market.

The panel discussion as led by Drs. Kakita, Maloney, and Baltz allowed for a spirited debate between clinical and research physicians and our partners in the pharmaceutical industry.  It is safe to say that a greater level of understanding was reached on both sides as to the intricacies of providing care in a rapidly changing medical landscape, and the evening radiated a spirit of optimism as to the future of Dermatology.

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