Treating Acne in the Age of Managed Care

                                                                                         

Patient Referrals
o The gatekeeper system may retard access to dermatologists and other specialists.
o Financial penalties may contribute to why primary care physicians sometimes do not refer patients to dermatologists.
o Another contributing factor when patients are not referred to dermatologists is that some primary care physicians may see acne as a disease that is not very serious or important.
o More patients than previously may be treated by their primary care physician rather than by a dermatologist. Primary care physicians may treat acne according to guidelines created by the managed care companies rather than selecting more individualized treatment for each patient. This is not the most effective way to treat acne.
o Due to the gatekeeper system, patients may wait longer periods of time before seeing a dermatologist. This can result in worsened acne or scarring.
Limitations on Care
o Some managed care companies will not pay for acne surgery, or they require a predetermination before such treatment.
o Managed care companies set up formularies and make it difficult for dermatologists to prescribe medications outside the formulary, even when that therapy may be better.
o In some cases, managed care companies will allow only a certain number of visits to a specialist, then the patient must return to his or her primary care physician.
Cost Effectiveness
o A treatment is cost-effective if it clears the disorder much more readily, and the patient sees the physician for fewer visits.
o Cost-effectiveness is a function of the correct medication being given to a specific patient, who uses it in the correct way.
o When patients must choose between less expensive drugs that are on managed care formularies and more expensive ones that the physician thinks are best, they often choose the less expensive ones.
o Managed care companies pay dermatologists lower fees than they received previously.
o By preventing the physician from utilizing the best therapies, managed care companies may increase the cost of treatment due to an increased number of visits and medications.
Retinoids
o Most acne patients can benefit from using a topical retinoid, today's gold standard of treatment.
o Retin-A is on the formularies of many managed care companies, even though it is more irritating than other retinoids.
o Some managed care companies prohibit prescribing Retin-
Women who could benefit from Retin-A therapy for their acne are sometimes denied this treatment by managed care companies.
The Patient/Doctor Relationship
o Education, which is very important in getting patients to stay with treatments in the long term, is sometimes affected by managed care companies; doctors must see more patients and don't have the time to spend with each individual person.
o When patients change dermatologists due to a change in managed care company, they often want treatment

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