Cosmeceutical dispensing overtakes Rx products

"Patients look to dermatologists and dermatologic surgeons for anything related to cosmetic care," says Kenneth Beer, M.D., director of the Palm Beach Esthetic Center in West Palm Beach. "There has been a whole shift in dermatological therapy. There is a whole emphasis on aesthetic dermatology, which is why products like Botox are now so popular."

Drug dispensing changed

"The dispensing of prescription drugs by individual dermatologists has greatly diminished in the U.S. because of state regulations and managed care," Dr. Beer says. "Individual dermatologists have been marginalized. There are only a few larger medical centers that still dispense prescription drugs and compound dermatology products."

Several studies have identified prescription drugs in the U.S. as being the fastest-rising component of health care expenditures. A 1999 study in Modern Healthcare noted an estimate from Health Care Finance Administration (HCFA) that found spending on prescription drugs was rising about 12 percent annually.

Many managed care organizations have placed prior authorization requirements on the prescription of topical retinoids, like tretinoin, to curb prescriptions of the therapies for more cosmetic treatments.

Patients go to doctors with questions

Despite that transfer of responsibility from the physician's office to pharmacy benefit companies, Dr. Beer says patients are still contacting dermatologists if they have questions about the therapy or if they have an adverse reaction.

"Ultimately, the physician ends up dealing with the patient," Dr. Beer says. "The patients come back to ask physicians or call them about the drug that they have been prescribed. If a patient has a drug reaction, they call the doctor, and this is good because the physician should know what is going on with his or her patient. That's what a physician's job is. However, in previous years, when dermatologists dispensed medications they knew the patients and were able to discuss problems or questions with them in the office while the product was dispensed."

Compounding ingredients

The other change that the transfer in dispensing prescription medications from the individual dermatologist to pharmacy benefit firms has meant is that few dermatologists now have the opportunity to compound ingredients, according to Dr. Beer.

"Dermatologists used to be experts at compounding," he says.

In recent years, Dr. Beer says, "Dermatologists have lost the ability to do this, and most local pharmacies won't compound. Indeed, many of the products that were used for compounding have been forgotten or are no longer manufactured."

One such product, used by dermatologists both as a moisturizer and as a base for compounding, is Theraplex (Sirius Labs). This product all but disappeared until Dr. Beer was able to find it and, with a few other dermatologists, purchase it.

Dispensing cosmeceuticals

While dermatologists would have scoffed at the idea of dispensing cosmeceuticals two decades ago because they were not judged valid therapies, dermatologists and other physicians have now adapted to dispensing these products, Dr. Beer says.

"Everyone who interacts with patients wants to be in the aesthetic business," he says. "We are starting to see primary care physicians and gynecologists getting into the field of skin care. Like it or not, cosmeceuticals are what patients are requesting."

In terms of choosing product lines from cosmeceuticals, dermatologists should rely on the advice of colleagues who indicate firms with which they have already successfully worked.