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What are the financial and treatment access burdens associated with atopic dermatitis comorbidities?


Kathryn Schwarzenberger, MD

Clinical Applications

Dr. Schwarzenberger is the physician editor of DermWorld. She interviews the author of a recent study each month. 

By Kathryn Schwarzenberger, MD, FAAD, February 1, 2024

In this month’s Clinical Applications column, DermWorld Physician Editor Kathryn Schwarzenberger, MD, FAAD, talks with Wendy Smith Begolka, MBS, from the National Eczema Association, about her Annals of Allergy, Asthma, and Immunology paper, ‘Financial and treatment access burden associated with atopic dermatitis comorbidities.

DermWorld: You and your colleagues recently published an article on the financial and treatment access burden associated with atopic dermatitis comorbidities. Since some of our readers may have missed your article, can you summarize your study and key findings?

Headshot for Wendy Smith Begolka, MBS
Smith Begolka: Atopic dermatitis (AD) is associated with a considerable multidimensional burden of disease, which can include the presence of various comorbid conditions. With this study, the National Eczema Association (NEA) investigated the patient-reported frequency of both atopic and nonatopic comorbidities, prescription treatment use for comorbid conditions, and accessibility barriers to those treatments.

We found that AD patients were using, on average, nearly six prescriptions in the past year to manage their AD and associated conditions, and over one in four had challenges obtaining medications for their comorbid conditions. On top of this, most patients who faced an insurance coverage issue for a comorbid condition also faced at least one coverage issue for an AD prescription in the same 12-month period.

These findings indicate that negative impacts from coverage issues for AD treatments can be further exacerbated by treatment access issues faced for additional, related diagnoses, potentially leading to higher out-of-pocket costs, and challenges with treatment continuity.

DermWorld: What was the impetus behind this study?

Smith Begolka: NEA aims to understand all aspects of the lived experience of patients with eczema, including the impact of eczema treatment access issues. Our previously published research has shown that patients with AD often experience polypharmacy, high out-of-pocket costs, and insurance coverage issues for AD prescriptions. But we also know that AD patients often have one or more associated comorbidities that also require prescription treatments, yet little research has explored a holistic view of the access burdens AD patients face.

DermWorld: What would you say was the biggest challenge affecting care that you found?

Smith Begolka: The frequency with which coverage access issues occur for AD’s comorbid conditions is concerning. Previous NEA research has shown that AD patients facing insurance coverage issues sometimes miss doses of required prescriptions, resulting in AD flares, the need for other medications or emergency care, or giving up on trying to get the treatment altogether. This is likely true for those facing issues for comorbid prescriptions as well.

DermWorld: Were you surprised by any of your findings?

Smith Begolka: We were shocked to see the insurance coverage challenges with AD extend to its comorbid conditions as well. As we continue to learn more about the growing list of comorbid conditions that are associated with AD, this is an important area for further exploration and attention.

DermWorld: What, if anything, can dermatologists do to help their patients address these issues?

Smith Begolka: While physicians cannot always predict prescription coverage issues, they can help to minimize the added burdens on AD patients by advising on what to do if a prescription is delayed or denied, including how a care plan might need to be modified while a coverage issue is being resolved. Dermatologists can also facilitate cross-physician communication to limit polypharmacy where possible and align on treatment goals driven by optimal AD management.


Wendy Smith Begolka, MBS, is chief strategy officer of Research, Medical & Community Affairs at the National Eczema Association. Her paper appeared in the Annals of Allergy, Asthma, and Immunology.

Smith Begolka served as an advisory board member receiving honoraria for Pfizer, Amgen, and Sanofi/Genzyme; served as an investigator receiving research grants from Pfizer; and is an employee of the National Eczema Association. The remaining authors are employees of the National Eczema Association.

Disclaimer: The views and opinions expressed in this article do not necessarily reflect those of DermWorld.


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