- The Cost of Psoriasis Therapies: Considerations for Therapy Selection
- The price of living pain free: The high cost of psoriasis treatments in Canada
- GET THE FACTS ABOUT COSENTYX® AND HOW IT WORKS
- 5 Ways to Handle the Cost of Psoriasis Care
- Treatment for Psoriasis, Eczema, and Vitiligo
- What You Need to Know About Xtrac
- How Xtrac Laser Therapy Works
- Related posts:
The Cost of Psoriasis Therapies: Considerations for Therapy Selection
Abstract and Introduction
Purpose: The purpose of this article is to provide a review of the cost of psoriasis therapies from two sources as well as compare the average wholesale price (AWP), as listed in the 2003 Drug Topics Red Book to that of a popular Internet pharmacy.
Methods: Prices of therapies were obtained two ways: the AWP was recorded from the 2003 Drug Topics Red Book. A range and average price per gram (or mL) were calculated based on the smallest size or quantity available. In addition, a price comparison was made to values as they were reported online at drugstore.com. Monthly cost estimates were based on average systemic dosing and for topicals, 18 g/month (for 1% body surface area involvement).
Results: The prices of psoriatic treatment medications vary considerably — from the relatively inexpensive topical corticosteroids to the more costly biologic therapies. In the category of corticosteroids, a trend was evident between the overall price per gram of each class and the potency of each class. Class I and VI corticosteroids had an average price per gram (or mL) of $2.08 ($37/month/1% BSA) and $0.86 ($15/month/1% BSA), respectively. Nonsteroidal topical treatments had an average price per gram (or mL) $2.18 ($39/month/1% BSA). Systemic therapies have a wide range of costs. The total monthly expense, based on estimated average dosing, was calculated for methotrexate, acitretin, and cyclosporine and were $78.60, $400.50, and $735.00, respectively. Biologic therapies designed for continuous use cost roughly $1,300/month.
Discussion: There are numerous treatment options for psoriasis with a wide range of costs. In addition to significant challenges from a scientific perspective, psoriasis treatment is further complicated by the cost of the numerous medications. Prices reported in the AWP were similar in many instances to those listed at an Internet pharmacy. Many considerations should go into therapy selection for psoriasis and a comprehensive approach that includes cost will likely provide the best patient care.
Psoriasis can be a devastating disease and affects individuals not only physically and psychosocially, but financially as well. Given the cost and complexity of treatment regimens, the financial impact of psoriasis treatment can be significant for the patient and the health care delivery system. Caregivers should be equipped with information on treatment costs in order to provide the most appropriate patient care.
Psoriasis is a chronic relapsing inflammatory disorder of the skin that affects a significant number of the world’s population. The effect of psoriasis on quality of life is well documented and is similar to other major medical diseases (Feldman et al., 1997; Ginsburg & Link, 1993; Gupta & Gupta, 2000; Rapp, Feldman, Exum, Fleischer, Jr., & Reboussin, 1999). There are physical, social, psychological, and financial implications that factor into quality of life of those living with this difficult disease (Devrimci-Ozguven, Kundakci, Kumbasar, & Boyvat, 2000; Feldman et al., 1997; Fried et al., 1995; Ginsburg & Link, 1993; Gupta & Gupta, 1998; Koo, 1996; Ramsay & O’Reagan, 1988).
The overall annual cost of caring for individuals with clinically significant psoriasis has been estimated to be from $650 million to $2 billion in the United States (Javitz, Ward, Farber, Nail, & Vallow, 2002). There are multiple variants of psoriasis as well as numerous treatment strategies that may require multi-drug regimens. This creates a complicated arena in which the physician must operate. During the past 10 years alone there has been an explosion in medications available for psoriasis. As the paradigm of psoriasis treatment shifts, so do the costs associated with novel medications. Knowledge of this cost information is vitally important to the clinician as the financial impact of therapy should be a consideration when treatment decisions are made.
Although many patients may have supplemental payment plans such as private insurance, or governmental subsidization, cost should remain a concern for the clinician. Cost-effective prescribing on behalf of the clinician will serve to minimize potential financial impact on the patient as well as limit the burden on the health care delivery system that may be involved. The realized cost to the patient is essentially determined by the medication itself and associated manufacturing/distribution costs, pharmacy charges, as well as any supplemental payment on behalf of a second party. The factor that clinicians may be able to control is the choice of medication.
The treatment of psoriasis is complex, owing to the diversity of clinical variants and severity, relapsing/remitting course, and the profound number of treatments available to the clinician. One factor often overlooked in selection of therapy is cost. Certain psoriasis medications can be associated with significant cost on behalf of the patient. There are many factors that contribute to final patient cost; some of which are out of the clinician’s control. One piece of the patient’s cost equation is the direct cost associated with the medication to be used. The purpose of this manuscript is to arm the clinician with information so that informed treatment decisions may be made with patient cost as a primary consideration as well as to evaluate the Drug Topics Red Book (Medical Economics, 2003) as a reliable reflection of retail medication costs.
The price of living pain free: The high cost of psoriasis treatments in Canada
The rising cost of psoriasis medications
Dr. Kim Papp, a dermatology researcher based out of Waterloo, says that it doesn’t look like these prices will be going down anytime soon.
“We will never have drugs that cost less,” he says. “We as consumers or your physicians as prescribers have demanded more safety information. And in response, the federal government has had to put on more and more layers in conducting these studies and all that does is increase the cost of development.”
Unless patients have a good benefit package through their work it is nearly impossible for the average Canadian to afford these medications — a key flaw in Canada’s health care system, patient advocates say. According to a 2015 study published in the Canadian Medical Association Journal (CMAJ), “Prescription drugs in Canada are currently funded by a fragmented patchwork of public and private drug plans that varies by province and leaves many Canadians with little or no drug coverage at all… one in ten Canadians report they cannot afford to take their medications as prescribed.”
However, Kathryn Andrews-Clay, Executive Director of the Canadian Skin Patient Alliance, says that the provincial government is moving in a direction that could help resolve the problem.
Before and after photo of biologic psoriasis treatment .
According to Andrews-Clay, a lot of biologics, like Taltz, are working to get on public formularies. Formularies are a list of medications approved by the government in which patients will receive some financial aid which will help them pay for expensive drugs.
“The problems with biologics is that each province decides which ones they will list on public formularies,” says Andrews-Clay. “Say you’re on and you’re doing well and you’re happy with how your psoriasis is, we don’t want the government to come in and say ‘now you need to go onto inflectra because it’s cheaper for us,’ we want that decision to be made by the doctor and the patient,” she adds.
The future of biologics
It does look like biologics are going to be the future medication for patients suffering from severe psoriasis; and as of right now Papp says that they will continue to be one of the safer options for patients.
However, Andrews-Clay says, “Biologics, I would say, are the most potent of the drugs available. And they have only been around for about ten years. So, we don’t know yet what the effect will be on someone who has been on them for say 30 or 40 years.”
“I was in a focus group with some patients and one of them said, ‘even if you tell me that there is a chance of me getting cancer…I will take that risk because this works so well for me that I want to have a better quality of life now,’” she says.
As for the cost, it seems like the government of Ontario is working to implement biologic drugs into public formularies. Adalimumab, a biologic drug used to treat psoriasis patients, has recently been registered. While the registration of Adalimumab is a step in the right direction many problems still remain. This specific drug does not necessarily work on all patients. Therefore, until more biologics are introduced into provincial formularies Andrews-Clay says that psoriasis sufferers will remain paying for their costly treatments.
Johns sees this as a lingering problem that she will have to face over the next few years. “I can retire in the next year or two but there is no plan that I can buy that will actually cover the costs of these treatments.”
GET THE FACTS ABOUT COSENTYX® AND HOW IT WORKS
Do not use COSENTYX if you have had a severe allergic reaction to secukinumab or any of the other ingredients in COSENTYX. See the Medication Guide for a complete list of ingredients.
COSENTYX is a medicine that affects your immune system. COSENTYX may increase your risk of having serious side effects such as:
COSENTYX may lower the ability of your immune system to fight infections and may increase your risk of infections.
- Your doctor should check you for tuberculosis (TB) before starting treatment with COSENTYX.
- If your doctor feels that you are at risk for TB, you may be treated with medicine for TB before you begin treatment with COSENTYX and during treatment with COSENTYX.
- Your doctor should watch you closely for signs and symptoms of TB during treatment with COSENTYX. Do not take COSENTYX if you have an active TB infection.
Before starting COSENTYX, tell your doctor if you:
- are being treated for an infection
- have an infection that does not go away or that keeps coming back
- have TB or have been in close contact with someone with TB
- think you have an infection or have symptoms of an infection, such as: fevers, sweats, or chills; muscle aches; cough; shortness of breath; blood in your phlegm; weight loss; warm, red, or painful skin or sores on your body; diarrhea or stomach pain; burning when you urinate or urinate more often than normal
After starting COSENTYX, call your doctor right away if you have any signs of infection listed above. Do not use COSENTYX if you have any signs of infection unless you are instructed to by your doctor.
Inflammatory Bowel Disease
New cases of inflammatory bowel disease or “flare-ups” can happen with COSENTYX, and can sometimes be serious. If you have inflammatory bowel disease (ulcerative colitis or Crohn’s disease), tell your doctor if you have worsening disease symptoms during treatment with COSENTYX or develop new symptoms of stomach pain or diarrhea.
Serious Allergic Reactions
Serious allergic reactions can occur. Get emergency medical help right away if you get any of the following symptoms: feeling faint; swelling of your face, eyelids, lips, mouth, tongue, or throat; trouble breathing or throat tightness; chest tightness; or skin rash. If you have a severe allergic reaction, do not give another injection of COSENTYX.
Before starting COSENTYX, tell your doctor if you:
have any of the conditions or symptoms listed above for infections
have inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
are allergic to latex. The needle caps contain latex.
have recently received or are scheduled to receive an immunization (vaccine). People who take COSENTYX should not receive live vaccines.
have any other medical conditions
are pregnant or plan to become pregnant. It is not known if COSENTYX can harm your unborn baby. You and your doctor should decide if you will use COSENTYX.
are breastfeeding or plan to breastfeed. It is not known if COSENTYX passes into your breast milk.
Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Know the medicines you take. Keep a list of your medicines to show your doctor and pharmacist when you get a new medicine.
How should I use COSENTYX?
See the detailed Instructions for Use that comes with your COSENTYX for information on how to prepare and inject a dose of COSENTYX, and how to properly throw away (dispose of) used COSENTYX Sensoready® pens and prefilled syringes.
Use COSENTYX exactly as prescribed by your doctor.
If your doctor decides that you or a caregiver may give your injections of COSENTYX at home, you should receive training on the right way to prepare and inject COSENTYX. Do not try to inject COSENTYX yourself, until you or your caregiver has been shown how to inject COSENTYX by your doctor or nurse.
The most common side effects of COSENTYX include: cold symptoms, diarrhea, and upper respiratory infections. These are not all of the possible side effects of COSENTYX. Call your doctor for medical advice about side effects.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
5 Ways to Handle the Cost of Psoriasis Care
Psoriasis treatments can be very expensive. According to the National Psoriasis Foundation (NPF), one in three people with psoriasis have trouble paying for the cost of care. The issues range from having no health insurance to having health insurance with co-pays that are out of reach or no coverage for psoriasis treatments.
“There is no question that cost of treatment is a huge issue for many people with psoriasis,” says Colby Evans, MD, a dermatologist in Austin, Texas. “I would hope that no one sees their psoriasis go untreated because of the cost,” says Evans, who chairs the NPF’s National Phototherapy Copayment Task Force, which is working to help lower costs for patients.
Not only do frequent phototherapy treatments add up, but psoriasis medications can run into the thousands of dollars. A tube of topical psoriasis medications might cost between $500 and $600. And biologics, a relatively new class of treatment for psoriasis and psoriatic arthritis, can run $15,000 to $20,000 or more a year.
Steps to Save on Psoriasis Treatment
Fortunately, there are ways you can manage the cost of your psoriasis treatments and lower your out-of-pocket expenses. Here’s how:
1. Ask your doctor to prescribe generics. Generics are the best way to save money, Evans says. They may not be as effective as some of the newer topical creams, but they still can be quite helpful. Check your health insurance policy because, in some cases, getting your prescriptions by mail order can be less expensive than getting them from the pharmacy.
2. Do your own light therapy. If you have a $50 co-pay for doctor’s office visits and you need light therapy three times a week, it can cost you $600 a month. However, you can buy a home therapy unit. “They’re more expensive as an initial investment,” Evans says, “but if you can do it at home, you can save gas and travel time and office co-pays.” If you’re considering at-home treatment, discuss it with your doctor.
3. Apply for financial assistance. Anytime you’re struggling to get access to psoriasis or psoriatic arthritis medication, check out the NPF’s financial assistance resource center. The site lists many assistance programs for which you might qualify, notes Sarah Golomb, health and access coordinator at the NPF. Also, many drug manufacturers will provide biologics free to patients who show a need. Go to the manufacturer’s website to see what they offer. “The programs tend to be more encompassing than patients think,” says Evans. “You don’t have to be desperately poor to qualify. They may be helpful even for patients with middle-class incomes and may provide the medications at substantially reduced costs.”
4. Ask your doctor for samples. “Finding the right medication can be a long road,” Golomb says. “Ask your doctor how long before a treatment will prove to be effective or ineffective.” Knowing that will help you save money and time and prevent wear on your patience, she adds. Ask your doctor for samples before you invest in a 30- or 90-day supply. Also, pharmacy reps often leave coupons at the doctor’s office, which you can use to buy your medication.
5. Shop around. Pharmacy prices are more variable than people think, Evans says. “If you have a $20 co-pay regardless of the cost of the medication, it doesn’t matter where you go. But if you’re paying the full cost yourself, you might find there can be an enormous difference in the cost of a drug from pharmacy to pharmacy. Call around to local pharmacies and price the drug on reputable online pharmacies. You may find a substantial difference in costs.”
Speak Up About Psoriasis Costs
Some patients tend to be shy when it comes to talking about the cost of treatment with their doctor. They shouldn’t be, Evans says. “Maybe 20 or 30 years ago, doctors didn’t want to discuss costs. But that’s not the case today,” he stresses.
“Every dermatologist in America deals with the issues of cost. It’s not something that people should feel reserved about bringing up,” he says. “If it is an issue for you, you should bring it up with your doctor because they need to know. I don’t want you to leave my office and not get the treatment I prescribed because it’s too expensive.”
Doctors don’t know what every patient’s health insurance will and won’t cover. Every insurance company and every plan within that company can be different. Before you see your doctor, call your insurance company and go to your visit armed with a list of drugs for which you have no or a low co-pay. “If the one that is covered is not the one I would have prescribed but it will work, I need to know,” Evans says.
Treatment for Psoriasis, Eczema, and Vitiligo
Skin disorders can cause severe physical changes to the dermis, which is the thick layer of living tissue that sits below the epidermis, forming the skin. These patches can be large and may be challenging to live with. Skin diseases like psoriasis and vitiligo can make it uncomfortable to participate in certain activities. Thankfully, psoriasis and vitiligo are both treatable with Xtrac laser therapy.
What You Need to Know About Xtrac
Xtrac laser therapy requires multiple sessions to be effective. For most patients, ten or fewer sessions—each lasting approximately 20 minutes—is enough to effectively clear an affected area. These sessions usually take place between one-to-three times a week, depending upon your skin type and severity of condition.
Xtrac laser therapy does not hurt, and no recovery time following treatment is required. This means that no anesthesia, general nor local, is required with Xtrac therapy, reducing the procedure’s associated risks.
Following the treatment, a feeling of being sunburnt—characterized by redness, itching, and tenderness—may result. Xtrac laser therapy, while effective, is not totally without risks. If you have a family history of skin cancer, make sure you discuss this with your dermatologist prior to receiving treatment. Xtrac laser therapy may increase the risk of developing non-melanoma type skin cancers.
How Xtrac Laser Therapy Works
Xtrac uses carefully-focused laser light beams to target patches of skin that are affected by psoriasis or vitiligo. The first laser of its kind to be approved for treatment for psoriasis, the Xtrac laser can work wonders on affected skin. If medications, creams, and other lifestyle and dietary changes haven’t worked for you, Xtrac laser therapy may be the solution. You can even receive Xtrac laser therapy treatment while pregnant, nursing, or on any of a variety of prescription medications.
Because there are few risks to Xtrac laser therapy, nearly anyone can seek this type of laser treatment. In fact, Xtrac is even safe for children to use, when approved by a board-certified dermatologist. Plus, Xtrac is covered by most insurance plans including Medicare.
Xtrac laser therapy has also been approved to treat some types of eczema, too. Most health insurance and Medicare plans cover the treatment costs of Xtrac laser therapy.
If you suffer from psoriasis or vitiligo and are ready to learn more about the effectiveness of Xtrac laser therapy, we want to meet with you. Use the buttons below to find a clinician or a location that offers Xtrac laser therapy.