local care for the treatment of ichthyosis

Isabelle DREYFUS, Pharmacist, Clinical Research Associate for Disease Reference Center for Rare Skin

Pr Juliette Mazereeuw - HAUTIER, Dermatologist, Coordinator of Toulouse Diseases Reference Center for Rare Skin

Document signed by Dr. Pierre BEGUERIE, Pharmacist, President of the Regional Council of the Order of Pharmacists, Aquitaine

The application of creams and ointments is essential in ichthyosis. These local care aims to reduce dander and improve skin comfort and appearance of the skin. These treatments include simple moisturizers and / or creams in which are added agents which will enable a better detach the scales and the so-called keratolytics (urea, salicylic acid ...).

The patients with ichthyosis use very large amounts of creams every day which can represent a substantial budget. To limit the cost of treatment, it is best to move towards reimbursed products. To date, France, the only products reimbursed by the health insurance for patients with ichthyosis are Dexeryl® and compounding.

This document contains some information relating to the reimbursement of these drugs that can help you understand the repayment terms.

For Dexeryl ®,

Since April 17, 2010, the reimbursement rate of Dexeryl® was decreased from 35% to 15%. This reimbursement rate to 15% is signified by an orange sticker on the packaging of the drug. This support reduction is secondary to a general reassessment of the actual benefit with the drug (SMR), which was deemed insufficient.

The consequences of these changes are:

• If you have an ALD (Affection Long Term) and the Dexeryl® is prescribed according to treatment protocol, the Dexeryl® is still supported at 100% (contribution from you) by health insurance.

• If you do not have to ALD, Health Insurance supports 15% of the price of Dexeryl®. The remaining amount is to patient load, except in the case where the mutual agreement provides complete.

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Warning: This rebate rate to 15% have been recently established, the balance of the invoice may not have been foreseen by contracts or mutual insurance and therefore not be refunded. It is important to check in advance the table of services provided by your complementary health contract.

It is important in this case to ask your doctor to apply ALD.

Finally, it is possible that the Dexeryl® in the future, is not at all supported by the health insurance and therefore reimbursed at all.

Regarding the compounding,

A masterful preparation is a medicinal preparation made by the pharmacist, for a specific patient, following an order. It contains one or more active ingredients * mixed with one or more excipients *.

* Active ingredient product that enters the composition of compounding and gives it its therapeutic properties

* Excipients: component that has no therapeutic activity but which is incorporated in the preparation to allow mixing the active ingredient

The regulations governing the prescribing, dispensing and reimbursement of compounding was also recently amended (Decree No. 2006-1498 of 29 November 2006 and Decree of April 20, 2007, Health Insurance circular CIR-37/2007 & CIR -58 / 2008). This new regulation rather complex significantly reduced the number of compounding which may be reimbursed by health insurance.

For patients with ichthyosis, the criteria for the management of extemporaneous preparations are well defined and more favorable than for other diseases.

The pricing and reimbursement of compounding are established "ingredient by ingredient". Thus, the list of components that can be repaid in a masterful preparation for a patient with ichthyosis is:

• active ingredients: urea, sodium chloride, lactic acid, salicylic acid ointment, ointment Galen, cold cream, glycerol starch, glycerin, petrolatum.

• Simple excipients (type vaseline, beeswax, lanolin, glycerin ...) or compounds excipients (Excipial® type codexial® ...)

Warning: If the preparation contains a non-registered product on the list above, it can not be covered by the health insurance and must be paid by the patient.

When in doubt or in exceptional cases (CPAM can support some outstanding products after prior agreement), it may be advisable pharmacist to liaise with the medical control of the Health Insurance Fund.

In principle, dermatological extemporaneous preparations are supported to 65% by the health insurance, sometimes 35%.

• If you have an ALD (Affection Long Term) and compounding is required according to the treatment protocol, it will be supported at 100% (contribution from you) by health insurance.

• If you have no ALD , Health Insurance supports 35 or 65% of the amount of compounding. The remaining amount will generally be supplemented by additional health or your will be your responsibility.

• All these recent changes to the conditions and catch rates as well as loading system complexity can sometimes expose the patient to difficulties or raise questions on the part of health professionals. In these cases, do not hesitate to approach the Reference Centres or Competence specializing in the management of your disease. Alternatively, if you want, you go directly to the agencies the reimbursement of your medications (Health insurance, mutual ...).