Managed Care Specialty Pharmacy Field Report: Psoriasis and Psoriatic Arthritis Medications

During 2014 The Dermatologist’s sister publication, First Report Managed Care, conducted a survey of professionals in the managed care specialty pharmacy field to determine trends in managed care with a focus on specialty pharmacy. The survey was developed through the collaborative efforts of an Advisory Panel of key thought leaders in the managed care field and the editors of First Report Managed Care. Given that managed care is a major contributor to the execution of quality healthcare in the field of dermatology, the results on psoriasis and psoriatic arthritis (PsA) were compiled and summarized for the audience of The Dermatologist.
As discussed in depth throughout this supplement, psoriasis is an autoimmune disease in which excessive skin cell growth results in thick, discolored patches of skin. Some individuals with psoriasis may develop PsA, which occurs when the immune system attacks the joints, causing inflammation. According to the National Psoriasis Foundation, approximately 7.5 million Americans have psoriasis and 125 million people worldwide are affected. Between 10% and 30% of people with psoriasis will develop PsA.
The annual healthcare cost, including direct and indirect costs, for patients with psoriasis in the United States is approximately $11.25 billion, with work loss accounting for 40% of those costs. The direct healthcare costs are estimated to be $1.9 billion for individuals with PsA. In addition to topical treatments and oral medications, psoriasis and PsA may be treated with biologics in the form of injections or intravenous infusion. Psoriasis may also be treated with phototherapy in which the skin is exposed to ultraviolet light on a regular basis under medical supervision.
Survey participants were asked if they are involved in reporting adherence and/or compliance on the use of psoriasis and PsA medications obtained through specialty pharmacy, and 37.0% of survey participants said “never,” and 22.2% said a “moderate amount.” Another 18.5% of survey respondents said “rarely.” Furthermore, 11.1% of survey respondents selected “a great deal” and another 11.1% selected “occasionally” (Figure 1). (Please note numbers are rounded in charts.)
When survey participants were asked what percentage of specialty pharmaceuticals for treatment of psoriasis and PsA require in-office administration of the drug, 53.7% of respondents said 0% to 25% and nearly 30% said they were unsure. About 13% of survey participants indicated 26% to 50% of specialty pharmaceuticals for treatment of psoriasis and PsA require in-office administration of the drug (Figure 2).
More than half of survey participants (62.9%) said they always provide patients with safety information to supplement prescribing information in regards to the use of biologics, while 24.0% said it depends on the prescription and 11.1% said it depends on the insurance (Figure 3).