Purpose: Health plans may use a variety of strategies to manage the costs of biologics used in the treatment of psoriasis (PsO). Other factors, in addition to the biologic cost, may impact treatment access from the patient’s perspective. The purpose of this study was to describe health plan formulary management strategies for biologics used in PsO and to evaluate the types of costs associated with filling biologic prescriptions, from the patient perspective.
Method: Data were generated from the United States WPAI Recontact Study, administered to an Internet panel of self-identified PsO patients (aged ≥18 yrs), February-March 2009 and May-June 2010. Health insurance type, benefit design, and types of costs associated with filling biologic drugs used for PsO were collected.
Result: A total of 498 PsO patients (mean age=46 years; 57% female). The majority of patients (90%) reported currently having health insurance. The top three types of health insurance were identified by patients as employer-paid (44%), managed care (34%), and health maintenance organization (21%). Of those patients with current health insurance (n=449), 96% reported having PsO prescription medication coverage and 39% needed a referral to see a specialist. Co-pay or co-insurance was required for 93% of patients. Of all PsO patients, 135 were biologic users (96% reported having health insurance). Of biologic users, injectable/intravenous PsO medication coverage was reported as follows: 32% had coverage with higher co-pay, 28% had coverage with same co-pay as other medications, and 18% had coverage of the total expense. The patient cost of the biologic prevented 24% of biologic users from filling the medication at some point. The most frequently reported ancillary costs (beyond the cost of the biologic) associated with filling the biologic, from the patient perspective, were multiple visits to health care providers (36%), number of refills (28%), multiple visits to pharmacy (24%), and gas/tolls (18%).
Conclusion: The majority of PsO patients in the United States have health insurance with PsO medication coverage. Co-pay and co-insurance were common features of these health plan benefit designs. Patients considered other economic aspects, such as frequency of refills and visits to health care providers/pharmacy, as being associated with filling biologic prescriptions.