Recently, several insurers updated their formularies to offer patients with plaque psoriasis and psoriatic arthritis access to more treatment options without requiring them to follow step therapy protocols. This protocol required prior authorization process makes patients go through a series of steps, trying other medications and failing on them before the insurance company will pay for another available medication that may have been originally prescribed by their doctor.
Dr. Jerry Bagel, a certified dermatologist at Windsor Dermatology and an expert in the treatment of psoriasis, explains the importance of patients obtaining access to their recommended medications immediately and why it’s critical that dermatologists continue to encourage insurers to cover prescribed treatments from the outset.
Why is it important that patients have access to psoriasis therapies?
“We know that not every psoriasis treatment is right for everyone. Doctors have recommendations for the most appropriate therapies, patient responses to treatments vary, and each patient has their own preferences as well.
“That’s why when a patient with psoriasis recently told me that she was worried about the increased risks that come with certain injectable drugs, we decided on a medication that could be taken orally and with an acceptable risk-benefit profile at that time in her treatment regimen. It was an appropriate option for her.
“But her insurer declined our reimbursement request because they required she first step through a preferred formulary agent. As a result, she is considering foregoing treatment altogether.”
How common are situations like this in the treatment of psoriasis?
“Unfortunately, this story is not unusual. Nontreatment and undertreatment of psoriasis remains a significant problem in the U.S., according to the National Psoriasis Foundation (NPF). The main reason isn’t surprising; patients can’t get their insurance to cover their medication.”
“For example, another patient of mine with moderate to severe psoriasis was so self-conscious about his appearance that he rarely left home. I prescribed a treatment to help manage his disease, and he was eager to try it. But his insurer said we first had to try a Tier 1 treatment.”
“When the Tier 1 treatment did not work, the insurer agreed to the treatment that I initially prescribed. Within months, his condition improved. Today, he is feeling sufficiently self-assured to go bowling with his friends and start dating again. However, he may have reached that point months earlier if there had been no treatment delay or mandated step.”
In a perfect world, every psoriasis patient would get access to the chosen therapy for his or her specific situation.
How has access to psoriasis treatments changed over the course of your career?
“When I started practicing dermatology 35 years ago, insurers showed little interest in psoriasis treatments. It was not until biologics were introduced in the first decade of the 21st century that they began to take notice.
“Biologics and other targeted therapies provide additional therapeutic options for psoriasis. However, drug utilization review of preferred therapies with high market demand and high volume often prevents the use of new treatment options. Pharmacy benefit managers (PBMs) and insurers implement step therapy policies that favor the current preferred brands until the demand for the newer treatment is impactful enough to add it to their formularies as an additional option.”
How do step therapies affect doctors?
“These policies mean we doctors and our office staff spend too much time on the phone and filling out paperwork — time that could be better spent caring for our patients. As a doctor who has dedicated his life to helping patients, this is downright frustrating.”
What needs to happen to improve treatment access for psoriasis patients?
“In a perfect world, every psoriasis patient would get access to the chosen therapy for his or her specific situation. We must keep patients and doctors at the center of medical decisions. I hope that the recent progress we’ve seen from certain insurers in offering additional options is a sign of what’s to come, and this type of advocacy for appropriate treatments continues. If we help patients and physicians immediately access the prescribed psoriasis therapies, we could potentially improve thousands of lives.”