Medicare beneficiaries face surging dermatology drug costs, with specialty medications responsible for nearly all of the increase in spending, according to a new study published in JAMA Dermatology.

Researchers from Harvard Medical School analyzed Medicare Part D prescription data from 2013 to 2022, examining nearly 95 million drug claims from dermatologists and dermatology-focused nurse practitioners and physician assistants. Specialty medications, which include biologics that treat conditions like psoriasis and eczema, accounted for 98.4% of the overall spending growth — helping drive total Medicare dermatology drug spending from $768 million in 2013 to $2.95 billion in 2022, a nearly fourfold increase.

These high-cost treatments made up less than 3% of prescriptions by 2022, but their share of total dermatology drug spending jumped from about 31% in 2013 to nearly 81% in 2022.

Researchers noted that most of the spending was concentrated among a small group of drugs. Just 10 specialty medications accounted for more than 98% of all specialty drug spending during the study period, with newer treatments steadily gaining market share as prescriptions for older drugs declined, such as Enbrel, primarily used to treat moderate to severe rheumatoid arthritis, psoriatic arthritis, and plaque psoriasis.

“Most of the growth in specialty medication spending was due to increased prescribing rather than higher prices,” the study authors concluded. Seven newer therapies approved after 2013 — including Dupixent for atopic dermatitis and Cosentyx for psoriasis — accounted for approximately 70% of all spending increases.

By 2022, specialty medications averaged $5,872 per 30-day prescription compared to $42 for traditional dermatology drugs. While older specialty drugs such as Humira and Enbrel were prescribed less frequently than newer therapies, their prices increased by more than 9% annually.

Researchers noted that while these therapies expand treatment options for patients with skin conditions, their rising share of costs “highlights the need for policies that balance innovation, access and affordability” for Medicare beneficiaries.