{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:46Z","timestamp":1783509286360,"version":"3.55.0"},"reference-count":14,"publisher":"MDPI AG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,6,21]]},"abstract":"Abstract<\/jats:title>\n \n Background:<\/jats:bold>\n Onychomycosis is the most common nail disease seen in clinical practice. Medication safety, severity of disease, co-morbidities, concomitant medications, patient age, and cost are all important considerations when treating onychomycosis. Since cost may affect treatment decisions, we sought to analyze Medicaid formulary coverage of onychomycosis antifungals.\n <\/jats:p>\n \n Methods:<\/jats:bold>\n Public state Medicaid formularies were searched for coverage of FDA approved onychomycosis medications and off-label oral fluconazole. Total drug cost for a single great toenail was calculated using National Average Drug Acquisition Cost. Pearson correlation coefficients were calculated to compare coverage and cost, mycological cure rate, and complete cure rate.\n <\/jats:p>\n \n Results:<\/jats:bold>\n Oral terbinafine and off-label fluconazole were widely covered for onychomycosis treatment. There was poor coverage of oral itraconazole and topical ciclopirox, and no coverage of topical efinaconazole and tavaborole without step-edits or prior authorization. There was a significant negative correlation between medication coverage and cost (\n r<\/jats:italic>\n = \u22120.758,\n p<\/jats:italic>\n = 0.040). There was no correlation between medication coverage and mycologic (\n r<\/jats:italic>\n = 0.548,\n p<\/jats:italic>\n = 0.339) and complete (\n r<\/jats:italic>\n = 0.768,\n p<\/jats:italic>\n = 0.130) cure rates.\n <\/jats:p>\n \n Conclusions:<\/jats:bold>\n There is poor Medicaid coverage of antifungals for the treatment of onychomycosis, with step-edits and prior authorization based on cost rather than treatment safety and efficacy. We recommend involving podiatrists and dermatologists in developing criteria for insurance approval of onychomycosis treatments.\n <\/jats:p>","DOI":"10.7547\/21-221","type":"journal-article","created":{"date-parts":[[2022,7,14]],"date-time":"2022-07-14T10:56:31Z","timestamp":1657796191000},"page":"1-14","source":"Crossref","is-referenced-by-count":3,"title":["Poor Antifungal Coverage for Onychomycosis in a Cross-Sectional Analysis of Medicaid Formularies"],"prefix":"10.3390","author":[{"given":"Julianne M.","family":"Falotico","sequence":"first","affiliation":[{"name":"Weill Cornell Medicine, Department of Dermatology, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shari R.","family":"Lipner","sequence":"additional","affiliation":[{"name":"Renaissance School of Medicine at Stony Brook University, Stony Brook, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"B1","series-title":"J Am Acad Dermatol","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1016\/j.jaad.2018.03.062","article-title":"Onychomycosis: clinical overview and diagnosis","volume":"80","author":"Lipner SR","year":"2019","unstructured":"Lipner SR, Scher RK: Onychomycosis: clinical overview and diagnosis. J Am Acad Dermatol 80: 835, 2019.2995996110.1016\/j.jaad.2018.03.062https:\/\/www.webofscience.com\/api\/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000461037700014&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3"},{"key":"B2","series-title":"JAPMA","doi-asserted-by":"publisher","first-page":"503","DOI":"10.7547\/14-063.1","article-title":"A retrospective review of diagnostic testing for onychomycosis of the foot","volume":"105","author":"Blake N","year":"2015","unstructured":"Blake N, Zhu J, Hernandez G, et al: A retrospective review of diagnostic testing for onychomycosis of the foot. JAPMA 105: 503, 2015.10.7547\/14-063.1"},{"key":"B3","series-title":"Cutis","first-page":"E21","article-title":"Onychomycosis: current and investigational therapies","volume":"94","author":"Lipner SR","year":"2014","unstructured":"Lipner SR, Scher RK: Onychomycosis: current and investigational therapies. Cutis 94: E21, 2014.25566580"},{"key":"B4","series-title":"Indian J Med Microbiol","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1016\/S0255-0857(21)01924-1","article-title":"Onychomycosis\u2014epidemiology, diagnosis and management","volume":"26","author":"Kaur R","year":"2008","unstructured":"Kaur R, Kashyap B, Bhalla P: Onychomycosis\u2014epidemiology, diagnosis and management. Indian J Med Microbiol 26: 108, 2008.1844594410.1016\/S0255-0857(21)01924-1"},{"key":"B5","series-title":"Arch Dermatol","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1001\/archderm.142.10.1279","article-title":"Factors influencing coexistence of toenail onychomycosis with tinea pedis and other dermatomycoses: a survey of 2761 patients","volume":"142","author":"Szepietowski JC","year":"2006","unstructured":"Szepietowski JC, Reich A, Garlowska E, et al: Factors influencing coexistence of toenail onychomycosis with tinea pedis and other dermatomycoses: a survey of 2761 patients. Arch Dermatol 142: 1279, 2006.10.1001\/archderm.142.10.127917043182"},{"key":"B6","series-title":"JAPMA","doi-asserted-by":"publisher","first-page":"357","DOI":"10.7547\/13-110.1","article-title":"Therapies for onychomycosis: a systematic review and network meta-analysis of mycological cure","volume":"105","author":"Gupta AK","year":"2015","unstructured":"Gupta AK, Daigle D, Paquet M: Therapies for onychomycosis: a systematic review and network meta-analysis of mycological cure. JAPMA 105: 357, 2015.10.7547\/13-110.1"},{"key":"B7","series-title":"J Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1053\/j.jfas.2008.12.012","article-title":"Efficacy of debridement alone versus debridement combined with topical antifungal nail lacquer for the treatment of pedal onychomycosis: a randomized, controlled trial","volume":"48","author":"Malay DS","year":"2009","unstructured":"Malay DS, Yi S, Borowsky P, et al: Efficacy of debridement alone versus debridement combined with topical antifungal nail lacquer for the treatment of pedal onychomycosis: a randomized, controlled trial. J Foot Ankle Surg 48: 294, 2009.https:\/\/www.webofscience.com\/api\/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000265792800003&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f31942302910.1053\/j.jfas.2008.12.012"},{"key":"B8","series-title":"JAPMA","doi-asserted-by":"publisher","first-page":"155","DOI":"10.7547\/14-170","article-title":"Diagnosis and management of onychomycosis: perspectives from a joint podiatric medicine\u2013dermatology roundtable","volume":"106","author":"Vlahovic TC","year":"2016","unstructured":"Vlahovic TC, Joseph WS, Scher RK, et al: Diagnosis and management of onychomycosis: perspectives from a joint podiatric medicine\u2013dermatology roundtable. JAPMA 106: 155, 2016.10.7547\/14-170"},{"key":"B9","series-title":"JAPMA","doi-asserted-by":"publisher","first-page":"413","DOI":"10.7547\/16-183","article-title":"Point-of-care diagnosis of onychomycosis by dermoscopy","volume":"107","author":"Bodman MA","year":"2017","unstructured":"Bodman MA: Point-of-care diagnosis of onychomycosis by dermoscopy. JAPMA 107: 413, 2017.10.7547\/16-183"},{"key":"B10","series-title":"J Am Acad Dermatol","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1016\/j.jaad.2018.05.1260","article-title":"Onychomycosis: treatment and prevention of recurrence","volume":"80","author":"Lipner SR","year":"2019","unstructured":"Lipner SR, Scher RK: Onychomycosis: treatment and prevention of recurrence. J Am Acad Dermatol 80: 853, 2019.10.1016\/j.jaad.2018.05.1260https:\/\/www.webofscience.com\/api\/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000461037700015&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f329959962"},{"key":"B11","article-title":"National Average Drug Acquisition Cost","unstructured":"Medicaid.gov. National Average Drug Acquisition Cost. Available at: https:\/\/www.medicaid.gov\/medicaid\/prescription-drugs\/pharmacy-pricing\/index.html. Accessed October 10, 2021.https:\/\/www.webofscience.com\/api\/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000354498500030&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3"},{"key":"B12","series-title":"Br J Dermatol","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1111\/j.1365-2133.2010.09930.x","article-title":"Clinical diagnosis of toenail onychomycosis is possible in some patients: cross\u2010sectional diagnostic study and development of a diagnostic rule","volume":"163","author":"Garcia\u2010Doval I","year":"2010","unstructured":"Garcia\u2010Doval I, Cabo F, Monteagudo B, et al: Clinical diagnosis of toenail onychomycosis is possible in some patients: cross\u2010sectional diagnostic study and development of a diagnostic rule. Br J Dermatol 163: 743, 2010.https:\/\/www.webofscience.com\/api\/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000282046600013&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1111\/j.1365-2133.2010.09930.x20618320"},{"key":"B13","series-title":"J Cutan Med Surg","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1177\/1203475417733461","article-title":"Confirmatory testing prior to initiating onychomycosis therapy is cost-effective","volume":"22","author":"Gupta AK","year":"2018","unstructured":"Gupta AK, Versteeg SG, Shear NH: Confirmatory testing prior to initiating onychomycosis therapy is cost-effective. J Cutan Med Surg 22: 129, 2018.https:\/\/www.webofscience.com\/api\/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000429867600002&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f32895453410.1177\/1203475417733461"},{"key":"B14","series-title":"J Am Acad Dermatol","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1016\/j.jaad.2019.10.078","article-title":"Modeling of usage and estimation of cost for efinaconazole 10% topical solution in the treatment of onychomycosis","volume":"83","author":"Lin K","year":"2020","unstructured":"Lin K, Lipner SR: Modeling of usage and estimation of cost for efinaconazole 10% topical solution in the treatment of onychomycosis. J Am Acad Dermatol 83: 227, 2020.10.1016\/j.jaad.2019.10.07831712169"}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/japmaonline.org\/view\/journals\/apms\/aop\/21-221\/21-221.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/aop\/21-221\/21-221.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/aop\/21-221\/21-221.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:18:56Z","timestamp":1783505936000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/112\/5\/21221"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,21]]},"references-count":14,"URL":"https:\/\/doi.org\/10.7547\/21-221","relation":{},"ISSN":["8750-7315"],"issn-type":[{"value":"8750-7315","type":"print"}],"subject":[],"published":{"date-parts":[[2022,6,21]]}}}