DOCSLIB.ORG

Rising Costs and Potential Savings

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Rising Costs and Potential Savings Supplementary Online Content Song H, Adamson A, Mostaghimi A. Medicare Part D payments for topical steroids: rising costs and potential savings. JAMA Dermatol. Published online April 28, 2017. doi:10.1001/jamadermatol.2017.1130 eTable 1. Topical Steroids with Steroid Classes (All Available Strengths of Medication) and Steroid Groups eTable 2. Total Medicare Spending and Potential Savings and Total Out-of-pocket Costs and Potential Out-of-pocket Savings for Patients, Adjusted for Inflation and Reported in 2015 Dollars eTable 3. Changes in Utilization and Spending on Individual Brand and Generic Topical steroids, Arranged by Decreasing Claim Count This supplementary material has been provided by the authors to give readers additional information about their work. © 2017 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/29/2021 eTable 1. Topical Steroids with Steroid Classes (All Available Strengths of Medication) and Steroid Groups Brand Name Generic Name Steroid Classes Steroid Group Clobetasol Propionate Clobetasol Propionate I I Betamethasone Dipropionate Betamethasone/Propylene Glyc I I Diprolene Betamethasone Diproprionate I I Halobetasol Propionate Halobetasol Propionate I I Vanos Fluocinonide I I Temovate Clobetasol Propionate I I Ultravate Halobetasol Propionate I I Fluocinonide Fluocinonide I-III II Betamethasone Dipropionate Betamethasone Dipropionate I-III, V II Desoximetasone Desoximetasone II-III II Halog Halcinonide II II Topicort Desoximetasone II-III II Triamcinolone Acetonide Triamcinolone Acetonide III-VI III-IV Betamethasone Valerate Betamethasone Valerate III, V, VI III-IV Celestone Betamethasone Valerate III, V, VI III-IV Hydrocortisone Valerate Hydrocortisone Valerate IV, V III-IV Kenalog Triamcinolone Acetonide III-VI III-IV Clocortolone Pivalate Clocortolone Pivalate IV III-IV Cloderm Clocortolone Pivalate IV III-IV Westcort Hydrocortisone Valerate IV-V V-VI Hydrocortisone Hydrocortisone IV, V, VII V-VI Desonide Desonide V-VI V-VI Hydrocortisone Butyrate Hydrocortisone Butyrate V V-VI Locoid Hydrocortisone Butyrate V V-VI Desowen Desonide V-VI V-VI Synalar Fluocinolone Acetonide IV-VI V-VI Beta-Val Betamethasone Valerate V-VI V-VI Lokara Desonide VI V-VI Dexamethasone Dexamethasone VII VII Cortisone Acetate Cortisone Acetate VII VII Cortisone Cortisone Acetate VII VII Scalacort Hydrocortisone VII VII © 2017 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/29/2021 eTable 2. Total Medicare Spending and Potential Savings and Total Out-of-pocket Costs and Potential Out-of-pocket Savings for Patients, Adjusted for Inflation and Reported in 2015 Dollars Year 2011 2012 2013 2014 2015 Cumulative Inflation 5.40% 3.20% 1.70% 0.10% Reported in 2015 dollars Medicare spending Class I $60,053,785.01 $79,291,677.80 $103,147,079.54 $203,277,644.86 $423,013,599.98 Class II $67,421,682.99 $90,765,853.53 $107,365,932.07 $128,587,123.21 $143,605,111.25 Class III-IV $68,691,973.89 $90,544,199.88 $110,380,795.49 $119,435,429.78 $110,740,946.48 Class V-VI $33,313,451.59 $46,628,707.51 $90,512,330.86 $111,730,270.34 $88,571,769.62 Class VII $8,168,961.42 $8,213,593.26 $8,630,557.25 $9,030,277.58 $10,003,039.10 Total $237,649,854.90 $315,444,031.97 $420,036,695.21 $572,060,745.78 $775,934,466.43 Patient out-of-pocket spending Class I $10,506,414.28 $13,307,892.56 $16,303,976.37 $22,199,405.38 $37,680,690.12 Class II $9,534,508.82 $11,013,914.81 $13,472,106.98 $15,807,323.50 $20,840,714.71 Class III-IV $13,350,741.79 $16,893,045.00 $21,080,593.27 $23,618,274.89 $26,113,295.79 Class V-VI $5,766,485.22 $6,743,831.30 $10,480,588.81 $12,386,366.18 $14,600,018.53 Class VII $2,250,150.31 $2,333,827.57 $2,509,286.44 $2,259,671.87 $2,597,067.69 Total $41,408,300.43 $50,292,511.23 $63,846,551.87 $76,271,041.83 $101,831,786.84 Potential Medicare savings Class I $13,047,251.58 $10,270,442.97 $19,874,012.88 $71,012,400.15 $295,628,729.00 Class II $38,801,681.23 $35,288,329.59 $36,474,357.00 $20,539,301.70 $41,643,569.07 Class III-IV $4,221,897.74 $7,633,614.37 $14,851,665.75 $27,205,298.96 $28,500,998.40 Class V-VI $25,614,767.96 $38,222,443.45 $80,204,303.85 $77,112,822.83 $56,444,941.28 Class VII $394,464.34 $602,775.96 $276,517.24 $407,999.15 $552,080.30 © 2017 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/29/2021 Total $82,080,062.83 $92,017,606.35 $151,680,856.72 $196,277,822.78 $422,770,318.05 Potential out-of-pocket savings for patients Class I $842,980.19 $1,089,107.55 $1,557,101.68 $3,056,228.56 $14,597,525.28 Class II $3,342,973.39 $2,949,055.37 $3,449,943.08 $2,995,823.38 $1,771,475.94 Class III-IV $1,408,124.17 $1,426,259.62 $1,400,163.34 $2,227,737.81 $2,888,136.02 Class V-VI $2,381,023.54 $3,335,706.04 $6,542,972.97 $2,775,338.53 $6,217,349.66 Class VII $83,434.00 $90,839.40 $57,787.93 $46,868.25 $62,758.61 Total $8,058,535.29 $8,890,967.97 $13,007,969.01 $11,101,996.53 $25,537,245.50 © 2017 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/29/2021 eTable 3. Changes in Utilization and Spending on Individual Brand and Generic Topical steroids, Arranged by Decreasing Claim Count Name Brand/ Potency Total spending (2011- % change claim count % change % change average user spending Generic group 15) (2011-15) unit count (2011- (2011-15) 15) Triamcinolone Acetonide III-IV 53.82% -11.29% Generic $368,409,427.94 42.54% Clobetasol Propionate I $714,819,719.57 59.58% 57.25% 605.25% Generic Fluocinonide Generic II $235,734,559.62 3.09% 1.81% 396.25% Hydrocortisone V-VI $95,036,184.57 Generic 51.32% 49.02% 0.26% Dexamethasone VII $41,570,965.21 Generic 41.99% 15.24% -8.18% Desonide V-VI $260,404,370.18 Generic -8.49% -22.68% 330.05% Betamethasone II $132,211,780.87 35.23% Dipropionate Generic 27.23% 35.01% Desoximetasone II $157,365,347.50 Generic -20.68% -20.94% 14.18% Betamethasone/ I $76,021,731.44 Propylene Glyc Generic 13.73% 13.87% -3.56% Betamethasone Valerate III-IV $45,876,388.91 Generic 35.49% 31.40% 105.22% Hydrocortisone Valerate III-IV $66,877,666.08 Generic -5.75% -8.89% 354.41% Halobetasol Propionate I $61,025,871.51 Generic 9.80% 9.77% 192.88% Hydrocortisone Butyrate V-VI $10,835,888.80 -12.01% -75.53% 207.46% Generic Cortisone Acetate VII $2,469,755.51 Generic -79.89% -77.31% 364.92% Beta-val Brand V-VI $163,519.50 N/A N/A N/A Kenalog Brand III-IV $10,056,127.03 -62.25% -53.50% 119.99% Vanos I $15,914,241.15 -97.55% Brand -97.61% 483.36% Cloderm III-IV $6,078,882.83 -80.19% -74.63% 154.05% Brand Hanalog II $8,359,365.63 Brand -18.64% 1.65% 276.55% Celestone Brand III-IV $193,144.71 N/A N/A N/A © 2017 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/29/2021 Locoid Brand V-VI $3,891,971.35 -30.69% -15.73% 156.50% Topicort II $4,074,649.44 Brand 317.63% 572.56% 121.52% Ultravate I $310,066.54 -84.07% -85.22% 77.54% Brand Diprolene I $353,055.13 -27.33% -23.54% 90.45% Brand Temovate I $339,101.85 -27.86% -26.59% 100.80% Brand Cortisone VII $2,287.62 Brand N/A N/A N/A Desowen V-VI $195,151.58 Brand 820.00% 604.92% -52.39% Lokara V-VI $6,104.53 Brand N/A N/A N/A Westcort V-VI $7,935.59 N/A N/A N/A Brand Scalacort VII $3,420.26 N/A Brand N/A N/A Clocortolone Pivalate III-IV $2,301,708.03 N/A N/A Generic N/A Synalar V-VI $215,403.83 N/A N/A Brand N/A N/A=Not available because no value in either 2011 or 2015 © 2017 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/29/2021.
Load more

Recommended publications
  • MG40118C 1199 2H10 SEIU PDL Bifold V4 5/6/10 12:26 PM Page A
    MG40118C 1199 2H10 SEIU PDL BiFold_v4 5/6/10 12:26 PM Page a 1199SEIU Preferred Drug List Please take this guide with you the next time you visit your doctor. © 2010 Medco Health Solutions, Inc. All rights reserved. Medco is a registered trademark of Medco Health Solutions, Inc. If you have questions about your prescription drug benefit, visit www.medco.com or call Medco Member Services at (800) 818-6720. For questions about your 1199SEIU benefits, call the 1199SEIU Benefit Funds’ Member Services representatives at (646) 473-9200. FPO MG40118C FPO (Ed. 4/10) Medco manages your prescription drug benefit for the 1199SEIU Benefit Funds. MG40118C 1199 2H10 SEIU PDL BiFold_v4 5/6/10 12:26 PM Page 1 This Preferred Drug List includes classes of widely used drugs that are preferred by the 1199SEIU Benefit Funds. These medications have been carefully selected to provide safety and value. If you receive any generic drug or preferred brand, you will have no out-of-pocket expense (except for GNY Benefit Fund and Rochester-area members, who may have small co-payments for certain brand-name drugs). However, if you get a nonpreferred brand when a preferred drug is available, you will be responsible for the difference in cost between the preferred and nonpreferred drugs. (Please note that this list is subject to change.) Section II provides a listing of nonpreferred brands and their possible preferred alternatives. SAFETY CONSIDERATION SYMBOLS Here is a quick guide that explains our safety symbols. These symbols appear next to certain medications. A dose lower than the manufacturer’s guidelines is often recommended for people 65 and older.
    [Show full text]
  • (CD-P-PH/PHO) Report Classification/Justifica
    COMMITTEE OF EXPERTS ON THE CLASSIFICATION OF MEDICINES AS REGARDS THEIR SUPPLY (CD-P-PH/PHO) Report classification/justification of medicines belonging to the ATC group D07A (Corticosteroids, Plain) Table of Contents Page INTRODUCTION 4 DISCLAIMER 6 GLOSSARY OF TERMS USED IN THIS DOCUMENT 7 ACTIVE SUBSTANCES Methylprednisolone (ATC: D07AA01) 8 Hydrocortisone (ATC: D07AA02) 9 Prednisolone (ATC: D07AA03) 11 Clobetasone (ATC: D07AB01) 13 Hydrocortisone butyrate (ATC: D07AB02) 16 Flumetasone (ATC: D07AB03) 18 Fluocortin (ATC: D07AB04) 21 Fluperolone (ATC: D07AB05) 22 Fluorometholone (ATC: D07AB06) 23 Fluprednidene (ATC: D07AB07) 24 Desonide (ATC: D07AB08) 25 Triamcinolone (ATC: D07AB09) 27 Alclometasone (ATC: D07AB10) 29 Hydrocortisone buteprate (ATC: D07AB11) 31 Dexamethasone (ATC: D07AB19) 32 Clocortolone (ATC: D07AB21) 34 Combinations of Corticosteroids (ATC: D07AB30) 35 Betamethasone (ATC: D07AC01) 36 Fluclorolone (ATC: D07AC02) 39 Desoximetasone (ATC: D07AC03) 40 Fluocinolone Acetonide (ATC: D07AC04) 43 Fluocortolone (ATC: D07AC05) 46 2 Diflucortolone (ATC: D07AC06) 47 Fludroxycortide (ATC: D07AC07) 50 Fluocinonide (ATC: D07AC08) 51 Budesonide (ATC: D07AC09) 54 Diflorasone (ATC: D07AC10) 55 Amcinonide (ATC: D07AC11) 56 Halometasone (ATC: D07AC12) 57 Mometasone (ATC: D07AC13) 58 Methylprednisolone Aceponate (ATC: D07AC14) 62 Beclometasone (ATC: D07AC15) 65 Hydrocortisone Aceponate (ATC: D07AC16) 68 Fluticasone (ATC: D07AC17) 69 Prednicarbate (ATC: D07AC18) 73 Difluprednate (ATC: D07AC19) 76 Ulobetasol (ATC: D07AC21) 77 Clobetasol (ATC: D07AD01) 78 Halcinonide (ATC: D07AD02) 81 LIST OF AUTHORS 82 3 INTRODUCTION The availability of medicines with or without a medical prescription has implications on patient safety, accessibility of medicines to patients and responsible management of healthcare expenditure. The decision on prescription status and related supply conditions is a core competency of national health authorities.
    [Show full text]
  • Clinical Policy: Topical Agents: Corticosteroids
    Clinical Policy: Topical Agents: Corticosteroids Reference Number: OH.PHAR.PPA.92 Effective Date: 01/01/2020 Revision Log Last Review Date: Line of Business: Medicaid See Important Reminder at the end of this policy for important regulatory and legal information. Description TOPICAL AGENTS: CORTICOSTEROIDS – LOW POTENCY NO PA REQUIRED “PREFERRED” PA REQUIRED “NON- PREFERRED” DESONIDE cream, ointment (generic of Desowen®) ALCLOMETASONE cream, ointment (generic of FLUOCINOLONE ACETONIDE 0.01% cream, solution Aclovate®) (generic of Synalar®) CAPEX® shampoo (fluocinolone acetonide) FLUOCINOLONE body oil, scalp oil (generic of Derma- DESONATE®gel (desonide) Smoothe/ FS®) DESONIDE lotion (generic of Desowen®) HYDROCORTISONE cream, lotion, ointment HYDROCORTISONE ACETATE WITH ALOE gel HYDROCORTISONE WITH UREA cream (generic of Carmol HC®) PANDEL® cream (hydrocortisone probutate) PEDIADERM HC® kit TOPICAL AGENTS: CORTICOSTEROIDS – MEDIUM POTENCY NO PA REQUIRED “PREFERRED” PA REQUIRED “NON--PREFERRED” BETAMETHASONE DIPROPIONATE-CALCIPOTRIENE BETAMETHASONE DIPROPIONATE lotion (generic of Ointment Diprolene®) BETAMETHASONE VALERATE cream, lotion (generic of CLOCORTOLONE PIVALATE (generic of Cloderm®) Valisone®) CORDRAN® tape (flurandrenolide) FLUTICASONE PROPIONATE cream, ointment (generic of DESOXIMETASONE cream, gel, ointment (generic of Cutivate®) Topicort®) MOMETASONE FUROATE cream, ointment, solution FLUOCINOLONE ACETONIDE 0.025% cream, ointment (generic of Elocon®) (generic of Synalar®) PREDNICARBATE cream (generic of Dermatop®) FLUTICASONE
    [Show full text]
  • Steroids Topical
    Steroids, Topical Therapeutic Class Review (TCR) September 18, 2020 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, digital scanning, or via any information storage or retrieval system without the express written consent of Magellan Rx Management. All requests for permission should be mailed to: Magellan Rx Management Attention: Legal Department 6950 Columbia Gateway Drive Columbia, Maryland 21046 The materials contained herein represent the opinions of the collective authors and editors and should not be construed to be the official representation of any professional organization or group, any state Pharmacy and Therapeutics committee, any state Medicaid Agency, or any other clinical committee. This material is not intended to be relied upon as medical advice for specific medical cases and nothing contained herein should be relied upon by any patient, medical professional or layperson seeking information about a specific course of treatment for a specific medical condition. All readers of this material are responsible for independently obtaining medical advice and guidance from their own physician and/or other medical professional in regard to the best course of treatment for their specific medical condition. This publication, inclusive of all forms contained herein, is intended to be educational in nature and is intended to be used for informational purposes only. Send comments and suggestions to [email protected]. September
    [Show full text]
  • Medication List
    Medication List Walgreens Plus™ members receive discounts on thousands of generic and brand-name medications included on this Medication List, which is divided into two sections, “Value Priced” Medications and “Discounted” Medications*. The price for a medication identified as “Value-Priced” is listed below: Get savings up to 85% off Cash Prices • 30-day-supply drugs cost $5 (tier 1), $10 (tier 2) or $15 (tier 3) on Atorvastatin (generic Lipitor) and • 90-day-supply drugs cost $10 (tier 1), $20 (tier 2) or $30 (tier 3) Rosuvastatin (generic Crestor) †† The Discounted Medications section lists the discounts offered to Walgreens Plus members on other generic and brand-name medications not included in the Value-Priced Medication section. The price for a medication is based on its tier and whether it is a 30-day or 90-day supply†. There may be an additional cost for quanities greater than those listed. This discount prescription pricing applies only to Walgreen Plus members on prescriptions purchased in select Walgreens stores that are not billed to insurance and/or used in combination with other health or pharmacy benefit programs. For further details, see your pharmacist or Walgreens.com/Plus. VALUE GENERICS NAPROXEN 250MG TAB 2 60 180 Antifungal NAPROXEN 500MG TAB 2 60 180 Quantity NAPROXEN 375MG TAB 2 60 180 Drug Name Tier 30 90 NAPROXEN DR 500MG TAB 3 60 180 FLUCONAZOLE 150MG TAB 2 1 3 TERBINAFINE 250MG TAB 2 30 90 Asthma Quantity Antiviral Drug Name Tier 30 90 Quantity ALBUTEROL 0.083% INH SOLN 25X3ML 2 75 225 Drug Name Tier 30 90 AMINOPHYLLINE
    [Show full text]
  • A New Robust Technique for Testing of Glucocorticosteroids in Dogs and Horses Terry E
    Iowa State University Capstones, Theses and Retrospective Theses and Dissertations Dissertations 2007 A new robust technique for testing of glucocorticosteroids in dogs and horses Terry E. Webster Iowa State University Follow this and additional works at: https://lib.dr.iastate.edu/rtd Part of the Veterinary Toxicology and Pharmacology Commons Recommended Citation Webster, Terry E., "A new robust technique for testing of glucocorticosteroids in dogs and horses" (2007). Retrospective Theses and Dissertations. 15029. https://lib.dr.iastate.edu/rtd/15029 This Thesis is brought to you for free and open access by the Iowa State University Capstones, Theses and Dissertations at Iowa State University Digital Repository. It has been accepted for inclusion in Retrospective Theses and Dissertations by an authorized administrator of Iowa State University Digital Repository. For more information, please contact [email protected]. A new robust technique for testing of glucocorticosteroids in dogs and horses by Terry E. Webster A thesis submitted to the graduate faculty in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE Major: Toxicology Program o f Study Committee: Walter G. Hyde, Major Professor Steve Ensley Thomas Isenhart Iowa State University Ames, Iowa 2007 Copyright © Terry Edward Webster, 2007. All rights reserved UMI Number: 1446027 Copyright 2007 by Webster, Terry E. All rights reserved. UMI Microform 1446027 Copyright 2007 by ProQuest Information and Learning Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. ProQuest Information and Learning Company 300 North Zeeb Road P.O. Box 1346 Ann Arbor, MI 48106-1346 ii DEDICATION I want to dedicate this project to my wife, Jackie, and my children, Shauna, Luke and Jake for their patience and understanding without which this project would not have been possible.
    [Show full text]
  • Steroids, Topical Therapeutic Class Review
    Steroids, Topical Therapeutic Class Review (TCR) May 14, 2019 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, digital scanning, or via any information storage or retrieval system without the express written consent of Magellan Rx Management. All requests for permission should be mailed to: Magellan Rx Management Attention: Legal Department 6950 Columbia Gateway Drive Columbia, Maryland 21046 The materials contained herein represent the opinions of the collective authors and editors and should not be construed to be the official representation of any professional organization or group, any state Pharmacy and Therapeutics committee, any state Medicaid Agency, or any other clinical committee. This material is not intended to be relied upon as medical advice for specific medical cases and nothing contained herein should be relied upon by any patient, medical professional or layperson seeking information about a specific course of treatment for a specific medical condition. All readers of this material are responsible for independently obtaining medical advice and guidance from their own physician and/or other medical professional in regard to the best course of treatment for their specific medical condition. This publication, inclusive of all forms contained herein, is intended to be educational in nature and is intended to be used for informational purposes only. Send comments and suggestions to [email protected]. May 2019
    [Show full text]
  • A List of Medications That May Lower Your Patients' Costs
    A list of medications that may lower your patients’ costs INTRODUCTION Catamaran utilizes a Pharmacy and Therapeutics Committee (P & T Committee), made up of practicing physicians, pharmacists, and nurses to help ensure that our formulary is medically sound and that it supports patient health. This committee reviews and evaluates medications on the formulary based on safety and efficacy to help maintain clinical integrity in all therapeutic categories. FORMULARY DESIGN There are numerous formulary designs that can be used by a pharmacy benefits administrator. Catamaran has chosen a formulary structure which is open and incentive based. Open Formulary: features co‐payments for medications that are preferred and non‐ preferred brands, plus lower co‐payments for generic drugs. Incentive Based: features different co‐payments for medications that are on or off the formulary. In this type of formulary, the patient cost structure may be two‐tier, three‐ tier, or four‐tier design. USING THIS FORMULARY REFERENCE GUIDE TO HELP CONTAIN COSTS Many benefit sponsors use the Catamaran formulary to help manage the overall cost of providing prescription drug benefits. This formulary offers a wide range of medications from which to choose. We realize that this formulary reference guide may not include every drug from every manufacturer. However, choosing a preferred drug when it is appropriate can provide access to the necessary medications to stay healthy, at a cost that is more affordable. KNOWING HOW THE FORMULARY INFORMATION IS ORGANIZED The following formulary reference guide is designed so that generic products are listed first in each drug category. The preferred brand name products are listed next, and non‐preferred brand products are listed last.
    [Show full text]
  • Pre - PA Allowance Age 18 Years of Age Or Older Quantity 60 Grams Every 90 Days ______
    DOXEPIN CREAM 5% (Prudoxin, Zonalon) Pre - PA Allowance Age 18 years of age or older Quantity 60 grams every 90 days _______________________________________________________________ Prior-Approval Requirements Age 18 years of age or older Diagnosis Patient must have the following: Moderate pruritus, due to atopic dermatitis (eczema) or lichen simplex chronicus AND the following: 1. Inadequate response, intolerance or contraindication to ONE medication in EACH of the following categories: a. Topical antihistamine (see Appendix I) b. High potency topical corticosteroid (see Appendix II) 2. Physician agrees to taper patient’s dose to the FDA recommended dose, and after tapered will only use for short-term pruritus relief (up to 8 days) a. Patients using over 60 grams of topical doxepin in 90 days be required to taper to 60 grams topical doxepin within 90 days Prior - Approval Limits Quantity 180 grams for 90 days Duration 3 months ___________________________________________________________________ Prior – Approval Renewal Requirements None (see appendix below) Doxepin 5% cream FEP Clinical Rationale DOXEPIN CREAM 5% (Prudoxin, Zonalon) APPENDIX I Drug Dosage Form Diphenhydramine Cream Phenyltoloxamine Lotion/ Cream Tripelennamine Cream Phendiamine Cream APPENDIX II Relative Potency of Selected Topical Corticosteroid Drug ProductsDosage Form Strength I. Very high potency Augmented betamethasone Ointment, Gel 0.05% dipropionate Clobetasol propionate Cream, Ointment 0.05% Diflorasone diacetate Ointment 0.05% Halobetasol propionate Cream, Ointment 0.05% II. High potency Amcinonide Cream, Lotion, 0.1% Augmented betamethasone Cream,Ointment Lotion 0.05% dipropionate Betamethasone Cream, Ointment 0.05% Betamethasonedipropionate valerate Ointment 0.1% Desoximetasone Cream, Ointment 0.25% Gel 0.05% Diflorasone diacetate Cream, Ointment 0.05% (emollient base) Fluocinonide Cream, Ointment, Gel 0.05% Halcinonide Cream, Ointment 0.1% Triamcinolone acetonide Cream, Ointment 0.5% III.
    [Show full text]
  • Contact Dermatitis to Medications and Skin Products
    Clinical Reviews in Allergy & Immunology (2019) 56:41–59 https://doi.org/10.1007/s12016-018-8705-0 Contact Dermatitis to Medications and Skin Products Henry L. Nguyen1 & James A. Yiannias2 Published online: 25 August 2018 # Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Consumer products and topical medications today contain many allergens that can cause a reaction on the skin known as allergic contact dermatitis. This review looks at various allergens in these products and reports current allergic contact dermatitis incidence and trends in North America, Europe, and Asia. First, medication contact allergy to corticosteroids will be discussed along with its five structural classes (A, B, C, D1, D2) and their steroid test compounds (tixocortol-21-pivalate, triamcinolone acetonide, budesonide, clobetasol-17-propionate, hydrocortisone-17-butyrate). Cross-reactivities between the steroid classes will also be examined. Next, estrogen and testosterone transdermal therapeutic systems, local anesthetic (benzocaine, lidocaine, pramoxine, dyclonine) antihistamines (piperazine, ethanolamine, propylamine, phenothiazine, piperidine, and pyrrolidine), top- ical antibiotics (neomycin, spectinomycin, bacitracin, mupirocin), and sunscreen are evaluated for their potential to cause contact dermatitis and cross-reactivities. Finally, we examine the ingredients in the excipients of these products, such as the formaldehyde releasers (quaternium-15, 2-bromo-2-nitropropane-1,3 diol, diazolidinyl urea, imidazolidinyl urea, DMDM hydantoin), the non- formaldehyde releasers (isothiazolinones, parabens, methyldibromo glutaronitrile, iodopropynyl butylcarbamate, and thimero- sal), fragrance mixes, and Myroxylon pereirae (Balsam of Peru) for contact allergy incidence and prevalence. Furthermore, strategies, recommendations, and two online tools (SkinSAFE and the Contact Allergen Management Program) on how to avoid these allergens in commercial skin care products will be discussed at the end.
    [Show full text]
  • Cloderm® Cream (Clocortolone Pivalate 0.1%): a Moisturizing, Hydrating Formulation Enhances Epidermal Barrier Function
    CLINICAL INSIGHTS SUPPORTED BY PROMIUS PHARMA 2013, No. 2 Cloderm® Cream (clocortolone pivalate 0.1%): A Moisturizing, Hydrating Formulation Enhances Epidermal Barrier Function Leon Kircik, MD, FAAD It has been shown that application of some topical corti- DermResearch, PLLC, costeroids can increase TEWL and potentially contribute to Physicians Skin Care, PLLC, epidermal barrier dysfunction.6,7 In mice, application of topical Indiana University Medical Center, Indianapolis, IN, corticosteroids induced progressive increases in TEWL and a Mount Sinai Medical Center, New York, NY reduction in intercellular lipids in the SC.7 It is now well known The stratum corneum (SC) is a dynamic structure marked that even short-term use of topical corticosteroids can com- by multiple complex interactions and feedback loops.1-4 Self- promise epidermal barrier function and SC integrity by inhibit- repair of the permeability barrier has been documented; i.e., the ing epidermal lipid synthesis.8 However, certain formulations of SC can quickly adapt and initiate natural physiologic recovery. topical corticosteroids have been shown to improve skin hydra- Dysfunction of the SC is associated with specific disease states, tion and reduce TEWL.9,10 Perhaps the beneficial or detrimental perhaps most notably atopic dermatitis (AD), but also rosacea, effects of a given topical corticosteroid on TEWL have less to do psoriasis, and other inflammatory cutaneous disorders. More with the corticosteroid itself than with the vehicle in which it precisely, researchers and clinicians believe that AD may be is delivered.11 Thus, treatment becomes an act of balancing the driven in part by poor epidermal barrier function, perhaps as negative effects of the corticosteroid molecule itself on epider- a result of impairments in the permeability, immune response, mal barrier versus the positive impact of the vehicle that deliv- and antimicrobial barriers.
    [Show full text]
  • Appendix 6 – Characteristics and Safety Data from the Included Studies
    BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Open Appendix 6 – Characteristics and safety data from the included studies How safe are topical corticosteroids compared to emollient or vehicle? Study ID Study design and Intervention and Participants Cutaneous adverse events Systemic adverse events Unspecified adverse events (Systematic study duration comparator review*) (Quality assessment) Very potent topical corticosteroids Breneman 2003 RCT Intervention: Clobetasol Severity: moderate Local application site skin Unspecified adverse events (1) propionate 0.05% lotion (twice a to severe reactions Incidence comparable between 2 weeks treatment, then day) (n=96) No clinically significant groups. (unpublished) followed up for Age: ≥ 12 years telangiectasia or skin thinning additional 2 weeks Intervention: Clobetasol Treatment-related adverse (Feldman 2005 Sample size: 229 propionate 0.05% emollient events (2) Nankervis (3)) Cochrane risk of bias tool: participants cream (twice a day) (n=100) Clobetasol lotion = 4/96 patients randomisation described, (4.2%); Clobetasol cream = 1/100 allocation concealment Comparator: Vehicle (n=33) patients (1%) unclear, intention-to- Vehicle = 6/33 patients (18.2%) treat unclear. (Difference between groups: p= 0.0006a) Kimball 2008 (4) RCT Intervention: Clobetasol Severity: not Incidence of adverse events or (trial a) propionate emulsion specified in the treatment related adverse Duration not specified in formulation foam 0.05% review events (Frangos 2008 review Clobetasol foam = 8% (5)) Comparator: Vehicle Age: not specified in Risk of bias not assessed Vehicle foam = 10% the review in any of the included (no significant differences systematic reviews.
    [Show full text]