INTRODUCTION
Many of the oral small molecules (OSM) and biologic immune response modifier drugs share indications for use, such as in psoriasis and rheumatoid arthritis. The OSMs azathioprine, cyclosporine, methotrexate, and mycophenolate were approved for use by the US Food and Drug Administration (FDA) in the 1900s, so biologic immune response modifiers are on average far newer – tildrakizumab being approved by the FDA in 2018, for example, and risankizumab in 2019. Alefacept was the first biologic approved for the treatment of psoriasis in 2003. In addition, OSMs have the known possibility of severe side effects, such as bone marrow suppression1; and, as such, providers are less comfortable in prescribing them. On the other hand, the side effect profile of the biologic immune response modifiers has been less well characterized,2 leading to a lower comfort level when providers opt to prescribe these drugs.
The purpose of this analysis was to investigate the profile of providers who are high-volume prescribers of OSMs and those who are high-volume prescribers of biologic immune response modifier drugs. A better understanding of these provider characteristics can help us determine which factors lead to provider confidence when prescribing such complex medications, and whether these characteristics differ between providers primarily prescribing OSMs and those prescribing biologic immune response modifiers.
The purpose of this analysis was to investigate the profile of providers who are high-volume prescribers of OSMs and those who are high-volume prescribers of biologic immune response modifier drugs. A better understanding of these provider characteristics can help us determine which factors lead to provider confidence when prescribing such complex medications, and whether these characteristics differ between providers primarily prescribing OSMs and those prescribing biologic immune response modifiers.
MATERIALS AND METHODS
The Medicare Provider Utilization and Payment Data: Part D Prescriber3 was accessed for the years spanning 2013 to 2019. Data were filtered to dermatology providers and those prescribing OSMs and biologic immune modifiers. The OSMs consisted of apremilast, azathioprine, cyclosporine, methotrexate, and mycophenolate. The biologic immune modifiers consisted of abatacept, adalimumab, alefacept, brodalumab, certolizumab, efalizumab, etanercept, golimumab, guselkumab, infliximab, ixekizumab, omalizumab, risankizumab, rituximab, secukinumab, tildrakizumab, and ustekinumab.
The National Plan and Provider Enumeration System database4 were accessed. and the National Provider Identifier was cross-referenced from the Medicare Part D Prescriber database to the National Plan and Provider Enumeration System database to determine the provider's gender and years of experience. Years of experience were calculated by adding 4 years for
The National Plan and Provider Enumeration System database4 were accessed. and the National Provider Identifier was cross-referenced from the Medicare Part D Prescriber database to the National Plan and Provider Enumeration System database to determine the provider's gender and years of experience. Years of experience were calculated by adding 4 years for
