Early Adoption of Dupilumab in the Medicare Population in 2017

Background: In March of 2017, dupilumab became the first FDA approved injectable biologic for treatment of moderate-to-severe atopic dermatitis (AD). As the first drug in this class for AD, dupilumab has revolutionized the disease’s treatment and improved patient outcomes significantly. Previous work has demonstrated that dermatologic injectable biologics are not uniformly accessible to patients in the US, and that patients in more rural regions are less likely to have access to these medications. In this study, we aimed to evaluate the early utilization trends of dupilumab for the Medicare population in the first year of its FDA approval (2017). Methods: Retrospective cohort study of the Medicare Provider Utilization and Payment Data. Counties were categorized by Rural-Urban Continuum Codes (RUCC) based on size, extent of urbanization, and proximity to a metropolitan (metro) area as defined by the National Center for Health Statistics Urban-Rural Classification Scheme for Counties. Results: There were 142 individuals who prescribed dupilumab at least 10 times in 2017, 80% of whom were dermatologists. Of these providers, 130 (91.5%) practiced in metropolitan (metro) counties and 12 practiced in non-metro counties. There were 14 cities with two or more dupilumab prescribers, with highest numbers observed in New York, NY (8 providers); Philadelphia, PA (6 providers); Phoenix, AZ (5 providers); and Norfolk, VA (4 providers). Conclusions: There are differences in access to dupilumab in the Medicare population based on geographic location in the US. Trends of decreased access to novel dermatologic biologics in rural areas of the US may begin at their introduction to the market, identifying a potential target for future interventions to equalize access.