Does low-dose oral minoxidil affect blood pressure, heart rate?
In a study published in JAAD, researchers monitored blood pressure in 10 healthy male patients with androgenetic alopecia before and after taking their first dose of 5 mg oral minoxidil. The mean age of the men was 27.8 years. Patients were assessed with ambulatory blood pressure monitoring every 20 minutes for 24 hours on two different days: At baseline, and the day the first 5 mg dose was administered. Mean blood pressure and heart rate were calculated for intervals of two and four hours before and after intake of low-dose oral minoxidil.
[Androgenic skin conditions and hormonal IUDs. Read more in DermWorld Weekly.]
A nonsignificant reduction of systolic blood pressure occurred at two hours (–6.8 mm Hg from baseline) and four hours (–4.3 mm Hg from baseline) following ingestion. The authors conclude that for those with normal systolic blood pressure, low-dose oral minoxidil produces a minimal and mostly asymptomatic drop in blood pressure, particularly two hours after ingestion.
“Recently, there have been multiple studies exploring the use of low-dose oral minoxidil for treating many forms of alopecia with the goal of gaining hair while keeping adverse reactions at bay.” Read more in DermWorld Insights and Inquiries.
DermWorld Insights and Inquiries: The emergence of rituximab-induced pyoderma gangrenosum — An alert to dermatologists
Recognizing cutaneous adverse drug reactions is medical dermatologists’ forte. This commentary will focus on rituximab-induced pyoderma gangrenosum (RIPG) that characteristically presents as vulvovaginal pyoderma gangrenosum (VVPG) — a condition that I have not encountered (and hope that I never do). Dermatologists must be cognizant of this rare complication and its implications. Walsh et al published the first case of VVPG (reported as superficial granulomatous pyoderma [SPG] of the vulva) in a 51-year-old woman who presented with a six-week history of severe vulvar pain, bleeding, and rapidly progressing ulceration. Keep reading!
DermWorld Young Physician Focus: PBM tactics increase drug prices, lower patient access
Since 2014, the cost of all goods and services in the United States has increased 19%. However, the cost of prescription drugs has nearly doubled that, increasing 35%. Compared to patients in similar nations, Americans pay 2.5 and 3.4 times more for the same generic and branded drugs, respectively. Perhaps even more troubling: At least one study has shown that prescription drug insurance plans, like Medicare Part D, pay billions of dollars more than cash-paying patients do — for the exact same medications. In my column last month, I briefly mentioned prior authorization, step therapy, drug rebates, and clawbacks. These tactics utilized by PBMs contribute to increasing drug prices while simultaneously interfering with patients’ timely access to needed medications. Read more from DermWorld Young Physician Advisor Bridget McIlwee, DO, FAAD.
Filler reversal with hyaluronidase
The use of hyaluronidase — a naturally occurring enzyme that degrades hyaluronic acid (HA) — for the reversal of facial hyaluronic acid fillers is growing, despite little research and a lack of formal clinical guidelines on its use, according to Lily Talakoub, MD, FAAD, in MDedge. While hyaluronidase is FDA approved for several indications, its use in cosmetic procedures is off label.
[Earn CME with a Dialogues in Dermatology, an AAD member benefit.]
“Hyaluronidase is stored at cool temperatures (35-46° F). It can be reconstituted with saline, water, or bacteriostatic saline for reducing injection site pain; however, it should not be mixed with local anesthetic,” Dr. Talakoub said. The volume of diluent used depends on the surface area treated and ranges from 1 mL to 10 mL. Smaller volumes are used for more concentrated local injection and larger volumes for more precise dosing.
There are various clinical studies using hyaluronidase dilutions varying between five and 30 units to break down 0.1mg/mL of hyaluronic acid for the reversal of facial hyaluronic acid fillers. “In my clinical experience, the recommendation is that, apart from necrosis, the concentration used is titrated to clinical efficacy, which can also be done over multiple appointments every 48 hours until the desired outcome is achieved,” she said. It is recommended that any practitioner using hyaluronic acid fillers always keep two to three vials of hyaluronidase available in the event of a vascular emergency.
House bill would eliminate Medicare conversion factor cut in 2023
A bill that would provide relief from the nearly 4.5% scheduled cut in the 2023 Medicare Physician Fee Schedule conversion factor was introduced in the House this week by Reps. Ami Bera, MD, (D-CA) and Larry Bucshon, MD (R-IN). The conversion factor is a key component in determining Medicare physician payments and the anticipated cut as well as a 4% PAYGO cut mean physicians will face up to 8.5% in Medicare cuts next year. The bill, H.R. 8800, the Supporting Medicare Providers Act of 2022, also includes a “sense of the Congress” that the Secretary of Health and Human Services and Congress should take action to ensure financial stability and predictability in the Medicare physician payment system, promote and reward value-based care innovation, and safeguard timely access to high-quality care by advancing health equity and reducing disparities.
Why this matters: Mitigating financial distress for dermatology practices and ensuring continued patient access to care is the AADA’s top advocacy priority. While only part of the solution, this bill addresses the conversion factor cut, which is an important step.
Since 2001, Medicare physician reimbursement has risen just 11% while the cost of operating a medical practice has increased 39%, and inflation has risen 51%. Adjusted for inflation, Medicare physician reimbursement declined 20% from 2001 to 2021. In contrast, over the same period, Medicare updates for hospital and nursing facilities have increased by 60% or more.
Next steps: AADA members advocated for this bill during congressional meetings organized as part of the 2022 AADA Legislative Conference. Support for the bill is one of several asks aimed at eliminating the 8.5% in cuts next year and building a more stable Medicare system. In addition, AADA members on the Hill are asking for positive, inflation-based updates and elimination of the 4% Pay-As-You-Go sequester cuts triggered by passage of the American Rescue Plan Act.
What you can do: If you weren’t able to join the conference this year, you can still help support the AADA’s advocacy on this issue. Contact your members of Congress via the AADA Take Action Center and ask them to ensure Medicare stability for patients and physicians.
House passes prior authorization relief bill
The House of Representatives passed a bill that would provide oversight, reduce administrative burdens, and improve transparency of the prior authorization process in Medicare Advantage plans. The Improving Seniors’ Timely Access to Care Act (H.R. 3173/H.R. 8487) would:
Establish an electronic prior authorization (ePA) program.
Establish a list of items and services eligible for real-time decisions.
Standardize and streamline the prior authorization process.
Ensure prior authorizations requests are reviewed by qualified medical personnel.
Increase transparency and protect beneficiaries from disruptions in care.
The bill also lays the groundwork for waiving or modifying prior authorization requirements based on the performance of providers demonstrating compliance, such as by adherence to evidence-based medical guidelines and other quality criteria, as well as requiring a Government Accountability Office (GAO) report to Congress evaluating Medicare Advantage plans’ implementation of the bill’s requirements no later than four years after enactment of the Act.
Why this matters: According to the AADA’s 2020 Prior Authorization Survey, dermatology offices spend an average of $40,000 per year on additional staff to help manage the prior authorization process, which on average takes up 3.5 hours of work each day. Survey respondents reported that the time devoted to prior authorization could have been spent seeing at least five additional patients per day.
Next steps: A companion bill (S. 3018) is pending in the Senate. AADA members will advocate for this bill today at the 2022 AADA Legislative Conference.
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