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Why treating acne and rashes is getting so expensive

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A dermatologist in West Palm Beach, Fla., sent out a routine survey to four major national chain pharmacies in his region last year, asking for the costs of six dozen commonly used medications, including acne treatments, steroid creams and psoriasis drugs. Steven Rosenberg and his daughter Miranda, a medical school student, had done this twice before, but in 2014, they got a shock.

The prices, faxed back to him within a week, seemed way off. There were huge price increases -- some as big as 10-fold. When he got the list back from the first pharmacy, he thought it was a mistake. Then the rest of the responses began to arrive.

"We saw all the pharmacies were in the same situation in terms of their pricing,'" Rosenberg said. "We started to get complaints from the patients that their insurance was no longer covering medicine they’d been on for years or their copay had gone up so much."

On Wednesday, Rosenberg's study of dermatology drug prices was published in JAMA Dermatology, showing that, on average, the drug prices have quintupled since 2009. Of the 19 brand-name drugs included in the study, certain outliers showed massive price surges -- a 60-gram tube of a gel for a type of skin cancer increased from $1,686.78 for a tube to over $30,000. The gel is made by Valeant Pharmaceuticals, a company that has come under Senate investigation for its drug hiking practices.

But dermatologists said it was striking that big increases occurred across the board. Major price hikes didn't affect only special biologic drugs or pricey but powerful treatments for psoriasis. They also hit acne medications and steroids. They hit decade-old drugs as well as new ones.

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Studies showing that drug prices have increased in any field of medicine have become so common they may almost seem routine. But dermatologists argue that their corner of the pharmaceutical industry has been especially hard hit by a combination of price increases and the tendency of pharmacy plans not to put their drugs on preferred tiers, meaning patients bear more of the costs.

Mark Lebwohl, chairman of the dermatology department at Mount Sinai School of Medicine in New York, said his clinical practice has a full-time assistant whose main job is to battle insurance companies over reimbursement for drugs. He joked that what was once called a prescription pad is now more of "a suggestion pad."

"Most of the time when we write a prescription, it gets denied," said Lebwohl, who is also president of the American Academy of Dermatology.

It's difficult to pinpoint why these drug prices have risen so rapidly. Lebwohl traces the trend to sporadic shortages of some commonly used drugs, such as antibiotics. Even after those shortages were resolved, the drugs didn't settle back down at their original prices. Over the past three years, those price hikes that had seemed to be isolated incidents have extended more broadly over all drug prices.

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Dermatologists say that skyrocketing drug prices in their field haven't gotten as much attention as those affecting people with cancer or dire infectious diseases. But they note that the skin conditions they prescribe medications for are often more common.

"Most of the attention has been to cancer drugs and hepatitis drugs, those that are $1,000 per tablet," Rosenberg said. "They are prescribed so infrequently compared to the medications we prescribe. Dermatologic drugs are prescribed by pediatricians, internists, family physicians, OB-GYNs, you name it."

Lebwohl said his hope is that legislation introduced in several states aimed at capping co-pays and increasing transparency could have an effect.