The Cost of Care: Systemic Medications for Psoriasis

Managing the cost of chronic psoriasis can be daunting for patients

When coping with a chronic skin disease like psoriasis, patients can feel not only the burden of their diseases internally but also as a burden to their wallet. Treatment plans can be expensive. According to a health poll, approximately 33% of participants stated that either they or another household member opted to rely on home remedies or over the counter medications instead of visiting a healthcare provider due to the high cost of medical care.[1] While managing the cost of chronic psoriasis can be daunting, patient and health care provider can work together to create a care plan that best suits the patient's needs. In the style of choosing wisely, six questions that should be asked when someone is faced with a new diagnosis such as psoriasis include:[2]

 

1) What Treatments of Equal Value Are Available at a Lower Cost?

Generic medications and alternative therapies may be appropriate treatment courses for the management of the disease. Reducing the cost of treatment does not always mean compromising on the effectiveness of the options.[3] In psoriasis, other therapies such as light therapy, topical creams, or even another form of treatment may be best suited for the patient's needs.

 

2) Will This Medication Change the Course of the Illness or Just Make the Patient More Comfortable?

For many chronic diseases like psoriasis, an absolute cure has yet to be discovered and treatments are designed to help reduce and improve flares.[4] Psoriasis can increase risk of developing heart problems, heart disease, and joint problems.[5-7] Treatment of psoriasis can help reduce inflammation that can cause cardiac events as well as prevent further joint deterioration.[8]

 

3) What are the Benefits of This Medication and How Long Should the Patient Keep Taking This Medication If They See no Benefit?

While many medications can help significantly improve chronic illnesses like psoriasis, they can also take a while to see improvements. In many cases, improvement is seen over a matter of weeks to months. Unfortunately for chronic diseases, one pill does not usually resolve the entire problem of the illness. Patients and healthcare providers should work together to decide if a treatment is beneficial and if the current regimen should be continued.

 

4) What Are the Common Side Effects of This Medications and Will It Interact with Other Medications and Supplements?

Most medications and treatments can improve illnesses, but also come at a price in other areas. Several of the systemic treatments for psoriasis can help improve the inflammation but also cause an increased risk for other problems such as infections.[9]

 

5) What Can a patient do Now to Improve Health with This Illness?

Patients can often blame themselves for diseases that are beyond their control; psoriasis is not due to poor hygiene or an infectious disease, rather it’s a chronic illness stemming from within.[4]  Discussing the next steps can help the patient better understand their prognosis as well as maintain a healthy, happy life.

 

6) How Much Will the Medications Cost?

The cost of medications depends on whether the patient has insurance and how the insurances are contracted to cover the medications. There are several ways that a patient can consider reducing costs: 

  • Ask for a 90-day supply. Some medication co-pays are cheaper with a 90-day supply rather than having three 30-day supplies.
  • Ask for generic alternatives, though in some cases, a generic drug will not be cheaper than the brand-name medication.
  • Check with the pharmacy on similar alternatives. Pharmacies may be better aware of the insurance plans such that cheaper medication substitutions may be possible based on your insurance. The patient can call the pharmacy on the phone to save a trip into the pharmacy.

 

Medical Costs in Psoriasis

Table 1. Cost to achieve 75% improvement in Psoriasis Area Severity index over 12 weeks[10]

Medication

Cost Per Pill/Treatment

Patients normally need

Total Cost over 12 weeks

Methotrexate

$3.56 per 2.5mg tablet

patients taking between 3-10 tablets per week,

12-week cost between $170.88 and $569.60[10]

Cyclosporine

$2.53 for 25 mg tablet and $6.76 for 100 mg tablet

patients take 35 or 42 tablets per week,

12 week cost between $2364.32 and $3595.20.[10]

Acitrein

$30.39 per tablet

patients take 7 or 28 pills per week,

12 week cost between $3024 and $10,211.04[10]

UVB Phototherapy

$140 per treatment

3 treatments per week

12 week cost $5040 [10,11]

Ustekinumab

$6897.65 per 45mg and $13,795.27 per 90mg injections

Patient receive injections at week 0, week 4, and week 12.[12]

12 week cost between $13,864.28 and $27,728.49[10]

Adalimumab

$1170.54 per 40mg injection

Patients often need injections every two weeks or every 9-10 days[10]

12 week cost between $11,869 and $17,864[13]

Infliximab

$1856.55 for a 100mg vial

Patients need approximately 0.81 to 1.35 vials per week

12 week cost between $15,038.06 and $25,063.43[10,14]

Enteracept

$315.81 for 25 mg and $590.86 for 50 mg injections

Patients could have low dose once weekly, low dose twice a week, or high dose twice a week[15]

12 week cost between $7579.44 and $14180.64[10]

*Improvement in the Psoriasis Area Severity Index

The cost of these medications does not reflect the additional costs of medical visits, appointments, or laboratory assessments. Patient and healthcare provider should work together to determine which treatment will be best for both the patient's health and financial situation. 

IDS Callout

* This Website is for general skin beauty, wellness, and health information only. This Website is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. The information provided on this Website should never be used to disregard, delay, or refuse treatment or advice from a physician or a qualified health provider.

References

  1. Foundation KF. Data Note: Americans’ Challenges with Health Care Costs. 2017; Link to research.
  2. Lakhani A, Lass E, Silverstein WK, et al. Choosing Wisely for Medical Education: Six Things Medical Students and Trainees Should Question. Acad Med.2016;91(10):1374-1378; PMID: 27489017 Link to research.
  3. Gyawali B. Low-value practices in oncology contributing to financial toxicity. Ecancermedicalscience.2017;11:727; PMID: 28386297 Link to research.
  4. Psoriasis | DynaMed Plus. 2017; Link to research.
  5. Alexandroff AB, Pauriah M, Camp RD, et al. More than skin deep: atherosclerosis as a systemic manifestation of psoriasis. Br J Dermatol.2009;161(1):1-7; PMID: 19500102 Link to research.
  6. Kremers HM, McEvoy MT, Dann FJ, et al. Heart disease in psoriasis. J Am Acad Dermatol.2007;57(2):347-354; PMID: 17433490 Link to research.
  7. Wu JJ, Choi YM, Bebchuk JD. Risk of myocardial infarction in psoriasis patients: a retrospective cohort study. J Dermatolog Treat.2015;26(3):230-234; PMID: 25102892 Link to research.
  8. Zachariae H. Prevalence of joint disease in patients with psoriasis. American journal of clinical dermatology.2003;4(7):441-447; PMID:
  9. Doherty SD, Van Voorhees A, Lebwohl MG, et al. National Psoriasis Foundation consensus statement on screening for latent tuberculosis infection in patients with psoriasis treated with systemic and biologic agents. J Am Acad Dermatol.2008;59(2):209-217; PMID: 18485527 Link to research.
  10. D'Souza LS, Payette MJ. Estimated cost efficacy of systemic treatments that are approved by the US Food and Drug Administration for the treatment of moderate to severe psoriasis. J Am Acad Dermatol.2015;72(4):589-598; PMID: 25631851 Link to research.
  11. Almutawa F, Alnomair N, Wang Y, et al. Systematic review of UV-based therapy for psoriasis. Am J Clin Dermatol.2013;14(2):87-109; PMID: 23572293 Link to research.
  12. Leonardi CL, Kimball AB, Papp KA, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1). Lancet.2008;371(9625):1665-1674; PMID: 18486739 Link to research.
  13. Ahn CS, Gustafson CJ, Sandoval LF, et al. Cost effectiveness of biologic therapies for plaque psoriasis. Am J Clin Dermatol.2013;14(4):315-326; PMID: 23696234 Link to research.
  14. Reich K, Sinclair R, Roberts G, et al. Comparative effects of biological therapies on the severity of skin symptoms and health-related quality of life in patients with plaque-type psoriasis: a meta-analysis. Curr Med Res Opin.2008;24(5):1237-1254; PMID: 18355421 Link to research.
  15. Leonardi CL, Powers JL, Matheson RT, et al. Etanercept as monotherapy in patients with psoriasis. N Engl J Med.2003;349(21):2014-2022; PMID: 14627786 Link to research.