Policy priorities in detail

Step therapy requires patients to try insurer-preferred treatments before their health plan will cover a prescribed medication. For dermatology patients, this can mean trying multiple treatments even when previous therapies have failed or another option is more appropriate.

These delays can prolong symptoms, trigger adverse reactions and make chronic skin conditions more difficult to manage.

DCAN advocates for step therapy policies that:

• Allow timely exceptions when a required treatment is contraindicated, has already failed or is likely to cause harm.
• Recognize previous treatment history without requiring patients to repeat unsuccessful therapies.
• Consider the treating clinician's medical judgment.
• Provide clear, timely appeals.
• Protect patients who are stable on an existing treatment from unnecessary disruptions.

Non-medical switching occurs when a patient's medication changes because of insurance coverage or formulary requirements rather than clinical need. A medical switch, by contrast, occurs when a clinician changes treatment based on the patient's health or response to therapy.

For patients with chronic conditions such as psoriasis, psoriatic arthritis, atopic dermatitis and hidradenitis suppurativa, a forced switch can jeopardize disease control and create uncertainty about whether a replacement treatment will work.

Patients may experience:

• Worsening symptoms or loss of disease control.
• New side effects or tolerability concerns.
• Treatment interruptions.
• Additional coverage reviews and appeals.

DCAN advocates for policies that protect continuity of care and prevent unnecessary treatment changes driven by insurance requirements rather than clinical need.

Prior authorization requires health plans to approve certain medications or treatments before providing coverage. The process may involve extensive documentation, requests for additional information and appeals after a denial.

Delays can leave patients waiting to start treatment while symptoms persist or worsen, while clinicians spend valuable time navigating administrative requirements.

DCAN supports policies that:

• Establish timely, transparent coverage decisions.
• Reduce unnecessary paperwork and administrative burdens.
• Streamline electronic prior authorization.
• Provide clear explanations for denials and accessible appeals.

Dermatologic conditions vary in severity, symptoms and response to treatment. A medication that works for one patient may be ineffective or inappropriate for another, even when both have the same diagnosis.

Treating clinicians evaluate medical history, previous treatment response and safety considerations to recommend appropriate care. Coverage policies should recognize these individual needs and allow exceptions when standard requirements are not appropriate.

DCAN advocates for coverage policies that respect clinical judgment and support individualized treatment decisions.

Copay accumulator programs prevent manufacturer copay assistance from counting toward a patient's deductible or out-of-pocket maximum. Patients may therefore exhaust their assistance without making progress toward meeting these cost-sharing requirements.

For people with chronic dermatologic conditions who need ongoing, sometimes lifelong, treatment, unexpected expenses can make it harder to refill prescriptions and maintain disease control.

DCAN supports policies that promote predictable medication costs and reduce financial barriers that can interrupt treatment.

Government health programs may classify the same medical condition differently, contributing to inconsistent coverage or treatment access. These differences can impact all individuals with dermatologic conditions, especially people with vitiligo, an immune-mediated disease that causes loss of skin pigmentation and alopecia areata, an immune-mediated disease that causes hair loss.

When classification systems do not reflect current medical understanding, patients may face avoidable barriers to appropriate care.

DCAN works to raise awareness of these barriers and advocate for more consistent, medically accurate classification across government health programs.

Safe Step Act

Step therapy can require patients to try treatments that are ineffective or medically inappropriate before accessing a prescribed medication. The Safe Step Act seeks to establish protections for patients requesting exceptions to step therapy requirements in health plans covered by the legislation.

LOANS for Biomedical Research Act

Biomedical research advances scientific discovery and the development of new treatments. Supporting the research workforce helps sustain the expertise needed to advance medical innovation, including research relevant to dermatologic conditions.

Improving Seniors' Timely Access to Care Act

Prior authorization can delay treatment and create administrative burdens for older adults and their clinicians. The Improving Seniors' Timely Access to Care Act seeks to streamline prior authorization in Medicare Advantage through measures including electronic processes and greater transparency around coverage decisions.

Utilization Management Map

Explore state-level utilization management policies that may affect access to prescribed medications and treatments.

Prescription Drug Affordability Board Tracker Map

Prescription Drug Affordability Boards, or PDABs, evaluate prescription drug costs and may pursue affordability policies. Their authority and potential effects on patient access vary by state.

Explore DCAN's tracker to learn about state-level activity that may affect access to dermatologic treatments.