INTRODUCTION
Dermatology has seen a significant influx of new Food and Drug Administration (FDA) medication approvals in recent years. In the last decade alone, 39 new drugs for dermatologic indications have been approved.1 The advent of biologics and Janus kinase inhibitors has dramatically improved the management of several chronic and often difficult-to-treat conditions, including psoriasis, atopic dermatitis, alopecia areata, and vitiligo.2 Despite some of these new therapies demonstrating clinical superiority over existing treatments, the majority of practicing dermatologists still do not prescribe them.3 Limited studies in other specialties have analyzed new drug adoption parameters.4,5 To our knowledge this is the first study to quantitate the factors influencing a dermatologist's decision to adopt new medications.
The top three factors that dermatologists considered for new drug adoption were efficacy, insurance coverage, and side effect profile. Even if a drug is efficacious and safe, it likely will not be readily adopted by dermatologists if their patients cannot afford it. This highlights the importance of accessibility for new drugs to be integrated into practice. Additionally, for conditions such as atopic dermatitis and psoriasis, many insurance companies require that a patient trial older medications that are typically less effective before covering a newer therapy. This can delay treatment success and lead to significant morbidity.
This study was granted IRB exempt status. An anonymous online survey that included 10 considerations when starting a new drug was distributed to dermatologists at a national conference in October 2022. Each factor was scored by respondents using a scale from 0 (not at all important) to 100 (extremely important). The mean scores for each factor and subgroup analyses based on practice setting and years in practice were calculated using SPSS version 28.0.1.1.
Three hundred fifty-seven dermatologists responded to the survey (71% response rate). The top five factors influencing new drug adoption were reported efficacy (92.6), insurance coverage (87.1), reported side effects (86.1), the difficulty of treating the disease targeted by the drug (84.5), and data-driven publications in peer-reviewed journals (80.8). The bottom five factors were drug price (78.9), podium presentations (70.4), colleagues adopting drug usage (59.2), presentations by pharmaceutical reps (50.7), and poster presentations (45.8) (Table 1).
The subgroup analyses demonstrated that dermatologists practicing for at least 21 years placed a significantly greater value on pharmaceutical rep presentations than those in practice for 0 to 5 years or 11 to 20 years (57.1 vs 41.7, P=0.004 and 57.1 vs 47.7, P=0.04). Dermatologists in solo private practices also placed greater value on pharmaceutical rep presentations than those at academic centers (60.0 vs 37.7, P<0.001).
The top three factors that dermatologists considered for new drug adoption were efficacy, insurance coverage, and side effect profile. Even if a drug is efficacious and safe, it likely will not be readily adopted by dermatologists if their patients cannot afford it. This highlights the importance of accessibility for new drugs to be integrated into practice. Additionally, for conditions such as atopic dermatitis and psoriasis, many insurance companies require that a patient trial older medications that are typically less effective before covering a newer therapy. This can delay treatment success and lead to significant morbidity.
