Identification and management of oral isotretinoin use inconsistent with product labeling

A pharmacy claims database was assessed retrospectively to analyze which antiacne medications patients had used in the six months before receiving oral isotretinoin. Before being given a prescription for oral isotretinoin, at least 47% of patients in the database, and possibly as many as 72%, had not received conventional therapy (at minimum, a topical retinoid and an oral antibiotic), as advised in the product labeling. A prior authorization policy restricting oral isotretinoin to patients who were unresponsive to a topical retinoid, at least two other topical medications, and two oral antibiotics reduced oral isotretinoin utilization by 47% and the per member per month spend by 35%.