Off-Label Uses in Dermatology Often Missing From Compendia

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The compendia used by Medicare for making coverage determinations are inadequate for dermatologic illnesses, and there is considerable discrepancy between compendia.
The compendia used by Medicare for making coverage determinations are inadequate for dermatologic illnesses, and there is considerable discrepancy between compendia.

HealthDay News — The compendia used by Medicare for making coverage determinations are inadequate for dermatologic illnesses, and there is considerable discrepancy between compendia, according to a study published online Jan. 23 in JAMA Dermatology.

John S. Barbieri, M.D., from the University of Pennsylvania in Philadelphia, and colleagues examined the American Hospital Formulary Service (AHFS) Drug Information and the DRUGDEX Information System compendia for dermatologic conditions and focused on less common conditions that often require systemic treatment. A total of 22 chronic, noninfectious, non-neoplastic diseases with at least four systemic therapies were selected. A list of first-, second-, and third-line medications was created using the Treatment of Skin Disease, 5th Edition.

The researchers found that 30.7 percent of the 238 treatments evaluated were included in either compendium. Overall, 10 and 15 of 22 individual diseases had one or fewer treatments included in the DRUGDEX and AHFS compendiums, respectively. For 22.3 percent of the 238 medications, there was a discrepancy in which a medication was included in one compendium but not the other.

"The findings suggest that compendia recognized by Medicare for making coverage determinations have significant inadequacies with respect to inclusion of common, first-line, evidence-based treatments for dermatologic illnesses," the authors write. "It appears that policies to reduce the reliance on these compendia or supplemental compendia to capture the unique needs of patients with dermatologic illness should be developed."

One author disclosed financial ties to the pharmaceutical industry; one author receives partial salary support through a Pfizer Fellowship grant.

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