When a Medical Condition Isn’t Viewed as One

When we hear about people who are afflicted with multiple sclerosis, lupus or rheumatoid arthritis, we instinctively feel empathy for the pain and physical difficulties these individuals are experiencing, and we support the development of and coverage for effective treatments for their conditions. Not all autoimmune diseases, however, are viewed through the same prism, even though they too carry severe health ramifications.

Alopecia areata is an often disfiguring autoimmune disease affecting approximately 700,000 Americans with as many as 6.8 million people in the United States impacted by AA during their lifetime. Unfortunately for individuals living with this serious disease, there are currently no Food and Drug Administration-approved treatments.

A new research paper from Xcenda, AmerisourceBergen’s consulting arm, outlines the steps needed to change the trajectory of this disease for patients. As medical science progresses in developing a treatment for AA, policymakers and the U.S. health care infrastructure need to recognize that AA is an autoimmune disease that may have severe, lifelong psychological, emotional and other impacts on patients. There are actions that need to be taken to prepare for a future in which therapies become available.

First, health care payers in both the public and private sectors must develop coverage policies for FDA-approved treatments and ensure that AA patients have access to new treatments. Any future FDA-approved treatments should be deemed medically necessary, and patients should not face excessive cost-sharing burdens or utilization management barriers, such as prior authorization or step therapy requirements, that will restrict access. AA patients should also have affordable access to mental health services, given the psychological burden of the disease.

Second, the Centers for Medicare & Medicaid Services should recognize that current restrictions in Medicare Part D need to be revisited. For example, future FDA-approved treatments for AA should be considered medically necessary as is the case for atopic dermatitis and psoriasis.

And finally but certainly not least important, the medical community needs to better understand AA and the need for effective long-term treatment. Physicians need to understand the burden of the disease and care for their patients accordingly. New therapeutic advancements in AA must immediately find their way into treatment guidelines.

There are more than 100 known autoimmune diseases. Each one presents difficult and often painful challenges to those afflicted by it. AA is not a cosmetic concern — it’s an autoimmune disease that can have significant physical and physical consequences. There will be therapeutic solutions for this disease emerging from the drug development pipeline. Those making health care decisions in various venues need to take steps now to ensure that those treatments will be accessible to the patients who need them.


Jennifer Snow, MPH, is vice president of reimbursement policy insights at AmerisourceBergen Xcenda. Brett King, M.D., Ph.D., is associate professor of dermatology at Yale University School of Medicine.

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