Pharmacists Are Crucial Team Members When Managing Affordability, Access to Opzelura

In an interview with Pharmacy Times, Matthew Zirwas, MD, discusses the challenges and benefits of using ruxolitinib (Opzelura; Incyte) for atopic dermatitis and vitiligo. He addresses the significant financial burden associated with the medication, emphasizing the importance of pharmacists in navigating prior authorizations and accessing patient support programs. Zirwas also highlights the ease of patient compliance with ruxolitinib due to its rapid symptom relief, particularly for atopic dermatitis. For vitiligo, he stresses the need for patient education and ongoing communication, recommending the use of selfies to track and visualize subtle improvements, which can encourage continued adherence to the treatment.

Pharmacy Times: Considering the financial burden associated with specialty drugs like ruxolitinib, how often do you encounter issues with affordability and access? How can pharmacists best assist in helping patients navigate issues such as prior authorizations?

Matthew Zirwas, MD: It becomes a really challenging thing, so it's something I really think about a lot, because this drug is such a huge step forward in terms of how well it works and how safe it is compared to what we've had in the past. So, topical steroids, while they help with the symptoms of atopic dermatitis, they actually make the underlying disease worse by impacting barrier function. Drugs like tacrolimus, pimecrolimus, are not very effective drugs at all. Ruxolitinib is the first highly effective, very well tolerated drug we've ever had, and it is an absolute life changer for these patients. But it's expensive, right? So, the list price is in the range of $2000 a tube, which even if a patient has a 20% copay, that's not going to be affordable for most people. So, really, for our practice, it has become crucial to find some local pharmacies or some mail order pharmacies that really understand this drug, understand how important it is, and will really help us go through the prior authorization process and access the patient support programs from Incyte, who makes Opzelura. The other thing is, we really try to include in our e-prescriptions, you know, there should be a little note that's a little space that's notes to the pharmacist, and we try really hard to include in there where they have the atopic dermatitis and what medications they have tried in the past, because those are the 2 things that help most in getting the prior authorization approved.

Pharmacy Times: From your perspective, how critical is patient education and ongoing communication in ensuring ruxolitinib adherence? What specific counseling points do you emphasize?

Zirwas: Believe it or not, this is one of the easiest drugs to get compliance, as long as you teach people that they don't have to be overly concerned about that boxed warning. The reason it is such a good drug in terms of compliance for atopic dermatitis is how fast it works. Like, literally, they put it on and in 15 minutes the itch is significantly better. That really drives compliance, kind of the same way you would think of compliance with taking Tylenol for a headache. Well, you're kind of like ‘My head hurts. I really want it to stop hurting, so I'm going to take the Tylenol.’ So, therefore they're going to be compliant. ‘Oh, I'm itchy. I don't want to be itchy, so I'm going to put the cream on,’ and it gets better immediately. So, that aspect of compliance is actually one of the easiest drugs to get really good compliance.

Now, when we talk about it with vitiligo, it really goes back to emphasizing to patients that it's likely to take months before they see anything. I really encourage patients to take a selfie, you know, a couple of good selfies before they start, so that maybe after a month or 2 months or 3 months, they could take another selfie and compare them and look for even the tiniest bits of improvement. Hey, that edge is starting to move in a little bit. Hey, that little dot wasn't there before. And even seeing that little bit of improvement can actually give them the encouragement they need to continue being compliant. And they absolutely notice those changes much more effectively when they can look at 2 selfies side by side, rather than trying to be like ‘Well, is that spot there? Did that really?’ No. You look at the 2 selfies, you can see, you can detect subtle improvement much more effectively, and that subtle improvement is predictive of much more improvement to come, but it really encourages the patients to maintain their compliance.