Why can’t some Medicare patients get advanced therapy for skin disease, even after they’ve failed standard topicals? In this interview from the 2026 Horizons in Advanced Practice meeting in Atlanta, Georgia, dermatology physician assistant Louis Margulis, PA-C, explains how out-of-pocket costs under Medicare put advanced treatments out of reach for many of his patients, a lot of them veterans.

Margulis also talks about how dermatology treatment goals have changed. In psoriasis, the target has moved from partial improvement to complete skin clearance. For atopic dermatitis, he describes a layered approach that treats immediate symptoms first and then protects and heals the skin barrier over the long term.

For NPs and PAs managing busy clinics, he shares a practical framework from the meeting for making short patient visits count. Introduce yourself, make eye contact, and ask which concern the patient wants help with first.

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