By Steve Feldman, MD, as told to Kendall Morgan
For the last 29 years, I’ve specialized in treating patients with psoriatic disease, a chronic immune condition that includes psoriasis. I’ve been involved in studies where new drugs are being tested and in the development of new treatment guidelines. There were changes and new developments in treatment right from the beginning. There’ve been various topical treatment options, oral drugs, and then, more recently, the development of biologic treatments.
Biologics have revolutionized the management of moderate to severe psoriasis and other psoriatic conditions including psoriatic arthritis, but they also can cost tens of thousands of dollars per year. I’ve done a lot of research into these costs, and what I came to realize is that it’s hard to know how much any particular patient actually will pay for a particular drug. That’s because of contracts with insurers and other programs. So, keep in mind that the retail price of a drug isn’t an accurate reflection of how much you (or your insurer) will pay.
Still, these costs can be intimidating. I’ve had patients who lost their insurance not come to see me because they felt they couldn’t afford it. But there are lots of ways to get to low-cost or even free medications for those who can’t afford it otherwise. Health insurers often will specify which drugs they’re willing to pay for. If you don’t have insurance coverage, you might actually have more treatment options, not fewer. Many drug companies offer financial assistance through special support programs. You can look into financial assistance through nonprofit or government organizations, too. There may be a process involved, but you should never assume that treatment is out of reach simply based on your income or insurance status. Even if you think your household income is too high, you still might qualify for financial assistance or price breaks. It never hurts to ask.
If your symptoms are mild, you can save on costs even before you go to see a doctor. For mild psoriasis on the face or other sensitive parts of the body, for example, you can try over-the-counter treatments such as hydrocortisone ointment. It’s a relatively weak topical, but it may be strong enough. Topical tars can be messy and smelly, but they also can be effective if you’ll use them. Scalp psoriasis is common, and over-the-counter medicated shampoos can be useful there. Also, getting sun on psoriasis is a good way of treating it. We do phototherapy in the office, and that’s costly. But just spending time in the sun can make your psoriasis symptoms better.
When you go to the doctor, finding one who takes your insurance will keep your copays lower. If the doctor prescribes medications, I recommend going to GoodRx.com to see what the medicines cost at different pharmacies and what breaks are available. Even generics can be expensive, so it’s always a good idea to check and compare prices first. Sometimes there can be vast differences between pharmacies. Check if the medication is one that your insurer will cover.
If your doctor recommends phototherapy (also called ultraviolet light) treatments, these can cost a lot less than many of the biologic medications used for severe psoriasis. But, depending on your insurance coverage, it may actually cost you more in copays. As an alternative, see if you can find a tanning bed at a gym or somewhere else in your community. Oftentimes it’s possible to get unlimited access for a low monthly fee. It’s a good idea to talk with your doctor about any treatment you use, but home phototherapy, sunlight, and tanning beds can be reasonable ways of reducing costs even if your psoriasis is severe.
Another thing patients with psoriatic disease can do if they are doing well on a drug taken every 2 weeks is to try taking it every 3 or 4 weeks instead and see what happens. It might work to stretch the dosing this way, and that can lower the cost. However, if your prescription copay is low anyway, this may not affect your cost all that much. It’s best to let your doctor know if you are adjusting your medications and spreading the doses out this way, as it could make it more likely the treatment will stop working over time. This said, there are now lots of treatment options, so I don’t worry about this as much as I used to.
Keep in mind that you will need to see a specialist to get these prescription medications. Your primary care doctor most likely won’t have access to biologics. When you choose a specialist, make sure they have experience treating psoriatic disease and let them know about any financial concerns you have. I give patients my phone number and tell them that if they get to the pharmacy and the drug costs a lot, they can call me and see if there’s an alternative treatment or a financial assistance program available to lower the cost. I’ve seen too many patients who blindly filled a high-cost prescription when there was a way to pay less. I’ve also seen too many patients suffer by delaying needed treatment.
This doesn’t need to happen. There are many steps you can take, and help is available to lower your costs while ensuring that you get the treatment and care you need.