Although lower prices are enticing, ethical concerns surrounding this model warrant consideration and parallel those associated with concierge/cash-only dermatology practices. Refusal to accept insurance restricts the pool of patients who can benefit, specifically excluding those who depend on insurance to afford their medications, potentially further reducing access to medications for socioeconomically disadvantaged patients. The cash model could also discriminate against the sickest patients who would have to pay out-of-pocket for the most medications. Dermatologists must consider the impact that cash pharmacies can have on their patients.
DISCLOSURES
S.R.F. has received research, speaking and/or consulting support from a variety of companies including Galderma, GSK/Stiefel, Almirall, Leo Pharma, Baxter, Boeringer Ingelheim, Mylan, Celgene, Pfizer, Valeant, Taro, Abbvie, Cosmederm, Anacor, Astellas, Janssen, Lilly, Merck, Merz, Novartis, Regeneron, Sanofi, Novan, Parion, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate and National Psoriasis Foundation. He is founder and majority owner of www.DrScore.com and founder and part owner of Causa Research, a company dedicated to enhancing patients’ adherence to treatment. The remaining authors have no conflict of interest to declare.
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AUTHOR CORRESPONDENCE
Steven R. Feldman MD PhD sfeldman@wakehealth.edu
