PRESCRIBER INTENT VERSUS TREATMENT INITIATION FOR BIOLOGIC THERAPIES IN ATOPIC DERMATITIS: A REAL-WORLD ANALYSIS USING NORSTELLALINQ US LINKED E-PRESCRIPTION, CLAIMS, AND PAYER DATA
Author(s)
Allison Perry1, ilan behm, MPH2.
1New York, NY, USA, 2Norstella, Englewood, CO, USA.
1New York, NY, USA, 2Norstella, Englewood, CO, USA.
OBJECTIVES: Moderate-to-severe atopic dermatitis (AD) is associated with substantial disease burden, yet treatment initiation following biologic prescribing remains poorly characterized in practice. Electronic prescribing (e-prescribing) captures prescriber intent before pharmacy claims. This study quantified time-to-first-fill and non-initiation following biologic prescribing among adults with AD by biologic agent, payer type, and prescriber specialty.
METHODS: Using NorstellaLinQ linked US e-prescription, closed claims, and bridged payer data, we identified adults (≥18 years) with ≥1 AD diagnosis (ICD-10-CM L20.x) and prescription enrollment during 2022-2024. Index prescribing intent was defined as the first e-prescription for an AD biologic (dupilumab, tralokinumab, lebrikizumab, or nemolizumab). Time-to-first-fill was measured from e-prescription to the first matching pharmacy claim (NDC). Patients without a pharmacy claim during follow-up were classified as non-initiators. Outcomes were summarized by biologic, payer, and prescriber specialty.
RESULTS: Among 8,658 patients with an index biologic e-prescription, 4,748 (54.8%) initiated treatment, with a median time-to-first-fill of 15 days. Dupilumab comprised 97.5% of prescriptions and demonstrated a 55.2% fill rate (N=8,441). Newer biologics showed lower fill rates: tralokinumab 42.1% (N=197), lebrikizumab 27.3% (N=11), and nemolizumab 22.2% (N=9), although estimates should be interpreted cautiously given limited sample sizes. Medicaid and commercially insured patients had similar fill rates (74.1% vs. 73.9%), but commercially insured patients experienced substantially longer median time-to-first-fill (21 vs. 13 days). Medicare patients had a lower fill rate (56.1%) but shorter median time-to-first-fill (10 days). Dermatologists and non-dermatologists demonstrated similar initiation rates (54.1% vs. 55.4%) and median time-to-first-fill (17 vs. 15 days).
CONCLUSIONS: One-half of patients did not initiate biologic therapy following an e-prescription. Although commercial and Medicaid patients had comparable initiation rates, commercially insured patients experienced markedly longer treatment delays, consistent with greater administrative or access-related barriers. Linked e-prescription, payer, and claims data provide a novel view of the interval between prescribing intent and treatment initiation, informing access strategies and policy.
METHODS: Using NorstellaLinQ linked US e-prescription, closed claims, and bridged payer data, we identified adults (≥18 years) with ≥1 AD diagnosis (ICD-10-CM L20.x) and prescription enrollment during 2022-2024. Index prescribing intent was defined as the first e-prescription for an AD biologic (dupilumab, tralokinumab, lebrikizumab, or nemolizumab). Time-to-first-fill was measured from e-prescription to the first matching pharmacy claim (NDC). Patients without a pharmacy claim during follow-up were classified as non-initiators. Outcomes were summarized by biologic, payer, and prescriber specialty.
RESULTS: Among 8,658 patients with an index biologic e-prescription, 4,748 (54.8%) initiated treatment, with a median time-to-first-fill of 15 days. Dupilumab comprised 97.5% of prescriptions and demonstrated a 55.2% fill rate (N=8,441). Newer biologics showed lower fill rates: tralokinumab 42.1% (N=197), lebrikizumab 27.3% (N=11), and nemolizumab 22.2% (N=9), although estimates should be interpreted cautiously given limited sample sizes. Medicaid and commercially insured patients had similar fill rates (74.1% vs. 73.9%), but commercially insured patients experienced substantially longer median time-to-first-fill (21 vs. 13 days). Medicare patients had a lower fill rate (56.1%) but shorter median time-to-first-fill (10 days). Dermatologists and non-dermatologists demonstrated similar initiation rates (54.1% vs. 55.4%) and median time-to-first-fill (17 vs. 15 days).
CONCLUSIONS: One-half of patients did not initiate biologic therapy following an e-prescription. Although commercial and Medicaid patients had comparable initiation rates, commercially insured patients experienced markedly longer treatment delays, consistent with greater administrative or access-related barriers. Linked e-prescription, payer, and claims data provide a novel view of the interval between prescribing intent and treatment initiation, informing access strategies and policy.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD78
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care, Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Biologics & Biosimilars, No Additional Disease & Conditions/Specialized Treatment Areas