SKIN March 2019 Volume 3 Issue 2 Copyright 2018 The National Society for Cutaneous Medicine 122 RISING DERM STARS® Access to Injectable Biologic Medications by Medicare Beneficiaries: Geographic Distribution of U.S. Dermatologist Prescribers Jeffrey Cohen, MD1 1Department of Dermatology, New York University, New York, NY Background/Objectives: Injectable biologics (IB) have emerged as some of the most effective therapies for inflammatory skin disease and this study sought to examine the distribution of U.S. IB-prescribing dermatologists. Methods: This study used Centers for Medicare and Medicaid Services Medicare Provider Utilization and Payment Data: Part D for 2013-2015. Primary outcome measures included the densities of dermatologists who prescribed IB (etanercept, adalimumab, ustekinumab, secukinumab) in each U.S. county for any indication, represented as the number of biologic-prescribers per 100,000 Medicare Part D beneficiaries. Each county was assigned a nine-point Rural-Urban Continuum Code (RUCC) based on size, degree of urbanization, and proximity to metropolitan areas. The proportion of counties in each RUCC with a dermatologist who prescribes biologics was also explored. Results: 2,992 dermatologists (26.3% of dermatologists) prescribed IB in this study. The national density of IB-prescribing dermatologists was 7.22. Only 778 counties (24.8%) had at least one IB-prescribing dermatologist. The densities of IB- prescribing dermatologists in metropolitan counties were 8.07-8.12. The densities of IB- prescribing dermatologists were 4.55 and 6.51 for urban populations of greater than 20,000 people adjacent and non-adjacent to metropolitan areas, respectively. Urban counties with populations between 2,500- 19,999 and adjacent to a metropolitan area had a density of 2.03 and urban counties with the same population and not adjacent to a metropolitan area had a density of 2.84. Completely rural or urban counties with populations under 2,500 people had densities between 2.31-2.35. Conclusion: There are disparities in the availability of IB-prescribing dermatologists across urban-rural geographic settings in the U.S. with greatest access in large urban areas and very limited access in more rural settings. SKIN March 2019 Volume 3 Issue 2 Copyright 2018 The National Society for Cutaneous Medicine 123 Table 1: County Characteristics for Biologic-Prescribing Dermatologists (Derms) by Rural Urban Continuum Code (RUCC). Density represented as the number of dermatologists per 100,000 Medicare Part D beneficiaries (MPDB). RUCC Description No. Derms Prescribin g Biologics to MPDB No. MPDB Density of Derms Prescribing Biologics per 100,000 MPDB No. Counti es No. Counties without a Derm Prescribing Biologics to MPDB % Counties without a Derm Prescribing Biologics to MPDB 1 Counties in metropolitan areas of 1 million population or more 1665 20620651 8.07 431 193 44.8 2 Counties in metropolitan areas of 250,000 to 1 million population 740 9111095 8.12 379 183 48.3 3 Counties in metropolitan areas of fewer than 250,000 population 334 4120500 8.11 355 200 56.3 4 Urban population of 20,000 or more, adjacent to a metropolitan area 99 2178029 4.55 214 149 69.6 5 Urban population of 20,000 or more, not adjacent to a metropolitan area 45 691367 6.51 92 60 65.2 6 Urban population of 2,500 to 19,999, adjacent to a metropolitan area 50 2465176 2.03 593 552 93.1 SKIN March 2019 Volume 3 Issue 2 Copyright 2018 The National Society for Cutaneous Medicine 124 7 Urban population of 2,500 to 19,999, not adjacent to a metropolitan area 39 1373419 2.84 433 400 92.4 8 Completely rural or less than 2,500 urban population, adjacent to a metropolitan area 9 382825 2.35 220 212 96.4 9 Completely rural or less than 2,500 urban population, not adjacent to a metropolitan area 11 475060 2.32 424 414 97.6 Total 2992 41418122 7.22 3141 2363 75.2 SKIN March 2019 Volume 3 Issue 2 Copyright 2018 The National Society for Cutaneous Medicine 125 References: 1. Veilleux MS, Shear NH. Biologics in patients with skin diseases. J Allergy Clin Immunol. 2017;139(5):1423-1430. 2. Lebwohl MG, Kavanaugh A, Armstrong AW, et al. US perspectives in the management of psoriasis and psoriatic arthritis: Patient and physician results from the population-based multinational assessment of psoriasis and psoriatic arthritis (MAPP) survey. Am J Clin Dermatol. 2016;17(1):87-97. 3. Armstrong AW, Koning JW, Rowse S, et al. Under-treatment of patients with moderate to severe psoriasis in the united states: Analysis of medication usage with health plan data. Dermatol Ther (Heidelb). 2017;7(1):97-109. 4. Takeshita J, Gelfand JM, Li P, et al. Psoriasis in the US medicare population: Prevalence, treatment, and factors associated with biologic use. J Invest Dermatol. 2015;135(12):2955- 2963. 5. Ingram DD, Franco SJ. 2013 NCHS urban-rural classification scheme for counties. Vital Health Stat 2. 2014;(166)(166):1-73.