Prescribing Patterns for Topical Retinoids within NAMCS Data
March 2005 | Volume 4 | Issue 2 | Original Article | 172 | Copyright © March 2005
Rajesh Balkrishnan PhD, Julia C. Sansbury MD, Rahul A. Shenolikar MS, Alan B. Fleischer Jr. MD, Steven R. Feldman MD PhD
Objective: Fears of potentially costly use of topical retinoids for cosmetic treatment of photodamaged skin have resulted
in many managed care organizations placing prior authorization requirements on this class of medications. The purpose
of this investigation was to examine whether prescribing patterns of a nationally representative sample of US
physicians shed light on the incidence of use of topical retinoids for indications other than acne.
Methods: A retrospective, cross-sectional study of data from the National Ambulatory Medical Care Survey (1996-
2000) was used to examine the impact of physician specialty as well as patient diagnosis of acne on the probability of
retinoid prescription in weighted multivariate logistic regression models.
Results: Topical retinoids were prescribed in 0.4% (14.7 million out of 3.67 billion) physician visits for any diagnosis
in the 5-year period from 1996 to 2000, and in nearly 31% (12.0 million out of 38.7 million) of physician visits for a
diagnosis of acne. Topical retinoids were prescribed for acne in 77.1% of the cases. This finding held when individual
retinoids (tretinoin and adapalene) were examined separately. Clear age-related prescription trends are observed, with
a significant decrease in prescriptions beyond the teen years. In older patients, tretinoin prescribing did not decrease as
much as adapalene prescribing.
Conclusions: These data suggest that managed care organizations may want to examine their own data to determine the
optimum criteria for operation of prior authorization (PA) programs for retinoids. PA requirements for these medications
appear unnecessary in young patients, given the very small probability of non-acne related use. PA in older
patients might be targeted to those patients on topical retinoids (such as tretinoin) for which there is evidence of efficacy
in treatment of cosmetic photoaging.