Advanced Practitioner Biologic Prescriptions for Psoriasis

Jack Cush, MD

Jan 15, 2026 3:54 pm

Advanced practice clinicians (APCs; nurse practitioners and physician assistants) deliver a large share of US dermatologic care, accounting for 37% of clinicians and 27% of dermatology visits by 2020. A current JAMA Dermatology reports APC drug spending trends in dermatology, with a focus on specialty medications (eg, biologics).

Medicare & Medicaid Service data was used to identify dermatology-focused APCs. Prescriptions were derived from the Medicare Part D Prescriber dataset (2013-2022). 14 830 unique physician dermatologists were compared to 9918 unique dermatology-specific APCs for drug spending growth and prescribing intensity for all drugs vs specialty medications. All spending was reported in 2022 US dollars.

Between 2013 and 2022 there were 94 900 359 prescription drug claims. Here are the facts:

All drugs: prescription drug costs incurred by dermatology APCs rose from $140 million to $952 million (23.7% per year)
Specialty medication costs by Dermatology APCs increased from $24 million in 2013 to $744 million in 2022 (46.3% per year).
The share of specialty medication spending by dermatology APCs increased from 10.2% to 31.2%
- In this same time period there was faster growth in the number of dermatology APCs relative to MD dermatologists
  - Dermatology APCs rising from 2707 to 6819 (10.8% annually, from 21.2% to 37.8%)
  - MD dermatologists increase of 10 048 to 11 208 (1.2% annually)

The cost per prescriber-year (prescribing intensity), increased at similar rates between APCs (11.6%) and physician dermatologists (12.4%), but for specialty medication prescribing intensity increased faster for APCs (32.0% annually) vs MD dermatologists (24% annually).

Dermatology-specific APC share of total drug spending tripled between 2013 and 2022, reflecting both increases in the number of APCs and the share prescribing any specialty medications.

APC share of spending