New Year Deductibles and Reimbursements

Welcome to Business Unblemished, a video series that explores the business side of dermatology. Each episode will feature practice owners, managers, business leaders, and other experts sharing best practices to streamline operations, improve patient care, and navigate daily challenges.

In this episode, Erik Domingues, MD, (Founder & CEO, Modern Dermatology) and Leslie Lucas, MBA, (COO, Oakview Dermatology) break down essential updates for 2025, including insurance benefits and changes impacting patients, updates to patient assistance programs, and the Inflation Reduction Act and its effects on dermatology practices.

Insurance changes: starting the year proactively

With each new year, insurance benefits reset, and dermatology practices need to be proactive. Leslie Lucas emphasizes the importance of treating every patient as if something has changed, whether it's a job change, aging into Medicare, or new coverage details. Practices should:

• Request updated insurance information at every check-in
• Verify deductibles and out-of-pocket costs, particularly for surgical and biologic patients
• Train front-desk staff to confidently collect copays and discuss financial policies with patients

Dr Domingues shares that his practice requires annual patient sign-off on financial policies, ensuring transparency and clear expectations. Lucas adds that thorough staff training, including scripting for financial conversations and understanding how insurance impacts billing, can improve workflow and reduce claim issues.

Medicare Part D reforms: expanding access to biologics

The Inflation Reduction Act introduces major Medicare Part D changes in 2025, significantly improving access to costly dermatologic treatments. Lucas outlines 3 key updates:

• Annual deductible remains at $257
• Out-of-pocket maximum drops to $2000 (down from $3300)
• Elimination of the "donut hole"—patients reaching the out-of-pocket limit no longer have additional costs for the year

For dermatology patients, these changes may increase affordability for biologics. Patients previously limited to topicals or traditional immunosuppressants may now be able to more easily access safer, more effective injectable and oral therapies.

Additionally, early financial planning can help patients manage biologic costs, as patients who enroll early can spread medication payments throughout the year, improving adherence and long-term outcomes.

Patient assistance programs: reapplications and eligibility changes

Patient assistance programs remain a critical resource, but eligibility thresholds are shifting in 2025. Dr Domingues and Lucas recommend reapplying for every patient, even if they were ineligible before.

Key updates include:

• Novartis, AbbVie, and Regeneron programs have adjusted eligibility criteria
• Both Medicare and commercially insured patients may see changes

Lucas highlights the importance of staff education so teams can effectively communicate financial assistance options to patients.

Planning for insurance and policy changes in your practice

Both experts stress proactive planning as the key to navigating insurance updates:

• Review and update processes for insurance verification
• Educate staff on policy changes so they can confidently assist patients
• Develop handouts and resources to help patients understand coverage updates
• Prioritize shared decision-making, balancing medical need with insurance realities

Dr Domingues underscores that the most important goal is ensuring patients receive the best possible treatment with minimal financial barriers. By staying informed and prepared, dermatology practices can streamline access to care and optimize patient outcomes.

Key takeaways:

• Verify insurance at every visit—patients’ benefits may have changed
• Medicare Part D reforms may expand access to biologics, lowering costs for patients
• Reapply patients for patient assistance programs, as eligibility requirements are shifting
• Educate staff on financial processes to improve workflow and patient experience
• Proactive planning ensures smoother insurance navigation and better patient outcomes