Nashville, TN—Psoriasis and psoriatic arthritis patients who consistently use specialty medications such as biologics have improved quality of life and better outcomes, but many Medicare beneficiaries simply can’t afford the drugs.
About 8 million patients in the United States are diagnosed with the chronic inflammatory skin disease, which often is associated with major comorbidities such as cardiovascular disease and psoriatic arthritis, with occurs in about 20% of psoriasis patients and can cause irreversible joint damage if left untreated, according to a new study in JAMA Dermatology.
Vanderbilt University School of Medicine–led researchers point out that biologics are a safe and effective treatment option for patients with moderate-to-severe psoriasis and psoriatic arthritis. Not only do those medications improve symptoms, but they also reduce the risk of comorbidities, they add.
With the growing cost of biologics, however, switching or discontinuing biologics has been linked to higher overall healthcare costs among patients with psoriasis, the authors advise. That is especially the case for Medicare beneficiaries who have no limit on their out-of-pocket spending. High-cost specialty medications might be out of their reach, and, even if the prescriptions are filled, they might not be used as regularly as prescribed, they add.
In this study, researchers looked at out-of-pocket costs associated with specialty medications for psoriasis and psoriatic arthritis—specifically biologics and oral small-molecule inhibitors—among Medicare beneficiaries, conducting a cross-sectional analysis of the Centers for Medicare & Medicaid Services Prescription Drug Plan Formulary Data from Q4-2020.
Analyzing 5,011 plan formularies for 15 specialty medications, the authors determined that coverage for the medications ranged from 10.0% to 99.8% across products and Part D plans.
Most of the plans, 90.5% to 100%, required prior authorization when products were covered.
In addition, quantity limits ranged from 1.0% of plans for guselkumab to 75.4% for tofacitinib, according to the report. Researchers also found that only 2.4% to 5.5% of plans offered the medications with a set copay during the initial coverage phase, with most requiring a percentage-based coinsurance for patient cost-sharing.
That meant that the median point-of-sale price excluding rebates or discounts ranged from $3,620.40 to $23,492.93 per fill. At the same time, estimated annual out-of-pocket costs ranged from $4,423 to $6,950. In terms of patients’ financial burden, the estimated per-fill out-of-pocket cost ranged from $1,234 to $3,426 for their first fill and $181 to $1,175 for fills under the catastrophic-coverage phase.
“Medicare beneficiaries needing specialty medications for psoriasis and psoriatic arthritis face very high out-of-pocket spending due to rising drug prices and the benefit’s reliance on coinsurance for patient cost-sharing,” the authors explain. “Psoriasis and psoriatic arthritis are chronic conditions; thus, treatment is long-term. Interruptions in treatment have been associated with worsening disease burden and associated comorbidities, such as cardiovascular disease.”
Researchers add that, while patient-assistance programs sometimes offset out-of-pocket spending, patients may be unaware of or not qualify for these programs because they are beneficiaries of a federal healthcare program.
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