Evaluating the Impact of Specialty Dermatology Medications on Medicare Part D Spending

A decade-long analysis of Medicare Part D claims has revealed a striking trend in dermatologic prescribing: specialty medications, while comprising less than 3% of prescriptions, now account for more than 80% of total drug spending by dermatology providers. The findings suggest that the explosive growth in spending is being driven less by rising drug prices and more by the accelerated uptake of newly approved, high-cost therapies.

Published as an economic evaluation of over 94 million prescription claims from 2013 to 2022, the study analyzed prescribing patterns from more than 24,000 dermatologists and dermatology-focused advanced practice clinicians, including nurse practitioners and physician assistants. Over that period, inflation-adjusted spending rose from $768 million in 2013 to $2.95 billion in 2022—an average annual increase of 16.1%. Nearly all of this growth—98.4%, to be precise—was attributable to specialty medications, most of them biologics or targeted agents approved by the FDA after 2013.

While these medications represented only 2.9% of total prescriptions in 2022, they consumed 80.9% of total dermatology drug spending. The main driver was increased prescribing of newer therapies such as Dupixent (dupilumab), Skyrizi (risankizumab), Taltz (ixekizumab), and Cosentyx (secukinumab)—treatments that have expanded the dermatologic arsenal for conditions like psoriasis, atopic dermatitis, and basal cell carcinoma but at a steep financial cost. In fact, 69.5% of all spending growth was linked to drugs approved after 2013.

Interestingly, the study found that average prices for specialty drugs rose modestly—about 5.1% per year in inflation-adjusted terms, reaching $5,872 per 30-day supply in 2022—while prices for non-specialty medications actually decreased by 5.3% annually, from $68 in 2013 to $42 in 2022. This suggests that the burden of rising costs isn’t due to runaway pricing alone, but rather a dramatic shift in what dermatology providers are prescribing.

Older biologics like Humira (adalimumab), Enbrel (etanercept), and Stelara (ustekinumab) showed slower increases in prescribing rates but experienced sharper annual price hikes—up to 9.2%—suggesting a lagging but still significant impact on the cost landscape.

For dermatologists, the findings reflect both progress and paradox. On one hand, the therapeutic advances of the past decade have revolutionized care for patients who previously had limited options or were reliant on broad-spectrum immunosuppressants. On the other, the concentration of spending in a narrow band of high-cost drugs raises critical questions about long-term sustainability, particularly within publicly funded insurance programs like Medicare.

The data also point to an emerging challenge: while the unit cost of some specialty medications is stabilizing or even declining with biosimilar entry and pricing reforms, the sheer volume of prescriptions—fueled by expanded indications and greater clinical familiarity—is steadily driving overall costs upward.

Health policy experts and dermatology leaders alike may find in these results a call for more targeted strategies to ensure access doesn’t come at the expense of affordability. This could mean more aggressive adoption of biosimilars, enhanced formulary management, or value-based pricing models tied to clinical outcomes.

Yet any discussion of cost must also acknowledge patient benefit. The rise of targeted biologics has changed the trajectory of many dermatologic diseases, offering relief from disfigurement, disability, and stigma. Balancing these outcomes against economic realities is no simple task. But as specialty medications take center stage in dermatology, the conversation is shifting—from whether we can treat advanced skin disease effectively, to whether we can afford to do so at scale.

For now, the takeaway is clear: dermatology’s drug spending story is increasingly a specialty drug story. And its next chapter may depend not just on innovation, but on how the healthcare system chooses to support and sustain it.