Advanced practice clinicians (APCs) appear to be prescribing specialty dermatology medications at a faster rate of growth than physicians, a small new study showed.

Edward I. Kong, PhD, and Arash Mostaghimi, MD, MPA, MPH, used the Medicare Part-D prescriber dataset to gauge drug spending growth and prescribing intensity (annual drug cost per clinician) by dermatologists and APCs for the years 2013 to 2022. The researchers recently published their findings in a letter in JAMA Dermatology.

Overall spending growth on specialty medications, defined as biologic therapies, was higher for dermatologists than for APCs. Almost 41% of APCs were prescribing any specialty drugs, compared to 47% of physicians in 2022. But the data indicated that APCs may be adopting specialty medications faster — at an annual growth rate of 15.4% compared to 11.1% for physicians.

“Although everybody is prescribing more, the growth rate has been faster for APCs,” Kong, who is pursuing an MD degree at the Harvard-MIT Health Sciences and Technology program, told Medscape Medical News.

He and Mostaghimi analyzed 94.9 million Medicare prescription drug claims from 9918 unique dermatology-specific APCs and 14,830 unique physician dermatologists.

APCs increased specialty medication spending by 46% per year, from $24 million in 2013 to $744 million in 2022. Physicians spending on specialty drugs in the same period grew by almost 26% annually, from $212 million to $1.6 billion.

The cost per prescriber per year — defined as prescribing intensity — rose by 11.6% for APCs and 12.4% for dermatologists. But specialty medication prescribing intensity by APCs grew faster — 32% per year compared to 24% for physicians.

The data seems to reflect both the increase in the number of APCs in dermatology, who account for about a third of clinicians and a third of visits in the field, and an apparent willingness to prescribe specialty medications, said Kong.

He and his co-author could not determine whether the prescriptions were appropriate, or whether they represented new prescriptions or refills.

But Kong said that the data could potentially tell a good story. “There’s been very little growth in the number of dermatologists,” while APCs have greatly increased, he said. 

“Potentially, this could just be all good in terms of having APCs expand access to medications that a lot of people are benefiting from,” he said.

In an editor’s note accompanying the Kong study, three JAMA Dermatology editors — Ivo Abraham, PhD, RN, University of Arizona in Tucson, Arizona; Adewole S. Adamson, MD, MPP, University of Texas in Austin, Texas; and Kanade Shinkai, MD, PhD, University of California, San Francisco — agreed with the authors that the data “suggest opportunities for expanding the reach of dermatologists utilizing this important and growing sector of the dermatology workforce.”

They noted that APC practice within dermatology has been “poorly studied and actively evolving within the dermatology workforce.” The Kong paper gives some important data on drug spending, they wrote, but also “raises questions regarding the scope of practice of APPs [advanced practice providers] in dermatology, how APCs can provide clinically effective and high-value care, and how they are best educated.”

Kong reported having no disclosures. Mostaghimi reported receiving consulting fees from Hims & Hers Health, AbbVie, Sun Pharma, Pfizer, Eli Lilly, Boehringer Ingelheim, Legacy Healthcare, Q32 Bio, and Astria Therapeutics, all outside the submitted work. Abraham reported owning stock in Matrix45. Matrix45 has received contract funding from Coherus BioSciences, ITM Radiopharma, Celltrion, G1 Therapeutics, European Commission, Eastern Research Group, CMR Institute, Mylan/Biocon, Morphosys, Sanofi, GSK, Syndax Pharmaceuticals, Disc Medicine, Jenner & Block, Fish & Richardson, Heuston Hannigan, and Rakoczy Molino Mazzochi Siwik outside the submitted work; and Abraham reported being Editor in Chief, Journal of Medical Economics (noncompensated but allotment of article publication cost waivers). 

Alicia Ault is a Saint Petersburg, Florida-based freelance journalist whose work has appeared in many health and science publications, including Smithsonian.com. You can find her on X @aliciaault and on Bluesky @aliciaault.bsky.social.