The Cost Burden of Psoriasis
Why treatment is so expensive and ways to reduce costs
Cliff Crumpton, a Florida-based contract field producer for the Travel Channel, HGTV, the History Channel and other networks, has tried natural salves and prescription creams and ultraviolet light therapy. He’s gotten cortisone shots. Crumpton also pays $2,000 per month in health insurance for himself, his wife and his newborn baby. The 34-year-old guesses he’s spent “in the thousands” out of pocket since he was diagnosed with psoriasis in 2008. His psoriasis persists.
The Cost Burden of Psoriasis
Crumpton isn’t alone. According to a systematic review published in JAMA Dermatology, patients with psoriasis could spend up to $8,000 per year treating their disease. The review found that the total cost burden of psoriasis rang in at $112 billion in the United States in 2013. Another report, in the Journal of Medical Economics, found that people with psoriatic disease spent 450 percent more on pharmacy costs in their lifetimes than the control.
Why is treatment so expensive, and what can we do to get a handle on costs?
To keep his psoriasis–and his need for expensive medications–in check, Crumpton has monitored his stress levels and adjusted his diet to include more anti-inflammatory foods, probiotics, and teas like kombucha and yerba mate.
“People laugh when they look in my fridge and they’re like, ‘What is all of this?’” Crumpton said in a telephone interview with HealthCentral.
Don't Supersize Me: Diet as a Means to Reduce Psoriasis Costs
Diet is perhaps the clearest way to cut the cost burden of psoriasis and potentially prevent the disease from worsening. A recent report, conducted in France and published in JAMA Dermatology, polled 3,500 people with psoriasis on their dietary habits. Those who adhered to the Mediterranean diet–one rich in healthy fats, fruit, vegetables, lean meats and whole grains–experienced less-severe disease progression.
“This finding supports the hypothesis that the Mediterranean diet may slow the progression of psoriasis,” write the study authors. “If these findings are confirmed, adherence to a Mediterranean diet should be integrated into the routine management of moderate to severe psoriasis.”
Why is psoriasis treatment so expensive, and what can we do to get a handle on costs?
Squeezing Money out of Topical Medications
There are other ways to cut costs with psoriasis, mainly by extending the lifetime of topical medications. Dermatologists recommend massaging topicals into the skin for deeper penetration of the skin barrier. Many people with psoriasis also use the wrap method: covering treated areas with plastic wrap to trap in medication and prevent rub-off.
But for some, including Crumpton, topicals don’t work for long. Cortisone shots clear up most of his psoriasis, which covers 30 to 40 percent of his body.
“I have to ask [my dermatologist] for it,” Crumpton says. “She doesn’t like doing it. She’ll give me the lecture; I understand it makes my bones weaker. That’s on me, just so I can go into work meetings and not have people think I’m on drugs or something.”
Crumpton’s dermatologist prescribed methotrexate — a low-dose chemotherapy drug used to treat psoriasis and psoriatic arthritis — but she advised him not to take it, and he hasn’t. She did not think it was the right medication for him but she wanted to get around insurers’ prescription guidelines, also known as step therapy, so she could treat Crumpton’s psoriasis with biologic medications.
Step Therapy Reforms
Crumpton, like psoriasis patients in most states, are required by insurers to try lesser-expensive medications before they’re covered for pricy but highly affective biologics, which can cost insurers $40,000 per month. This process is called step therapy, and psoriasis advocates are working to reform it.
Patrick Stone, vice president of government relations and advocacy at the National Psoriasis Foundation, says psoriatic disease is subjected to step therapy at much higher rates than other diseases. New York, Texas, Iowa, Indiana, and Illinois have all passed step therapy reforms. The NPF is lobbying legislators in other states, including Massachusetts, to provide a clearer appeal process when patients are denied coverage by their insurers.
“We hear arguments based on cost and they come from insurers themselves and aren’t grounded in truth,” says Stone in a telephone interview with HealthCentral, adding that step therapy can be more expensive in the long run if patients try everything before they’re approved for the right drug. “Insurers should not be dictating how medicine is conducted. That’s up to the doctors working in the system.”
Needed: A Way to Fix the Health Insurance System
After prescribing methotrexate, Crumpton’s dermatologist prescribed him the biologic medication, Stelara (ustekinumab), however his insurer, Florida Blue, denied coverage. Crumpton has appealed three times and has consulted an attorney about his options.
“It’s a very flawed system,” he says. “I feel these fast-food insurance companies are just taking money and they’re not always backing their clients.”
Since his coverage denials, Crumpton has taken to Twitter to share his story with the hashtag #OperationNewHealth. He says he’s not sure how to fix the system, but he wants other people to know they aren’t alone.
“It’s got to change, and it’s not just stopping at psoriasis,” he says. “That’s the whole goal of #OperationNewHealth. I feel like I have to talk about it.”
To learn more about #OperationNewHealth, follow Cliff Crumpton on Twitter @soflodad. For more information on the NPF’s step therapy initiatives, visit steptherapy.com.