High OOP Costs for Treatment of Psoriatic Disease Found in Medicare Beneficiaries


Medicare beneficiaries with psoriasis and psoriatic arthritis were found to pay high annual out-of-pocket (OOP) costs for treatment, which researchers attributed to rising drug prices and reliance on co-insurance for patient cost-sharing.

An analysis of recent CMS data indicates significant out-of-pocket (OOP) costs for treatment of patients with psoriatic disease covered by Medicare. Results were published today in JAMA Dermatology.

Although a safe and effective treatment option for patients with moderate to severe psoriasis and psoriatic arthritis, the cost of biologics has grown over time. Moreover, switching or discontinuing biologics has been linked with exacerbating overall health care costs among patients with psoriasis.

“High-cost specialty medications pose a considerable financial burden to Medicare beneficiaries who have no limit on their OOP spending,” noted the study authors. “In addition, high OOP costs for biologics have been linked to lower rates of medication adherence in patients with rheumatoid arthritis.”

Seeking to examine OOP costs associated with specialty medications for Medicare beneficiaries with psoriatic disease (psoriasis and psoriatic arthritis), they conducted a cross-sectional analysis of CMS Prescription Drug Plan Formulary Data from quarter 4 of 2020 that captured prerebate unit prices, plan coverage, cost-sharing details, and utilization management.

The study evaluated 5011 plan formularies for 15 FDA-approved specialty medications, including biologics and oral small molecule inhibitors, that are used to treat psoriasis and psoriatic arthritis.

Estimated OOP costs for nonsubsidized beneficiaries under the 2021 standard Medicare Part D benefit were calculated, in which 1 year of treatment and correct administration of treatment was assumed.

“To calculate OOP costs, we assumed no other medication use,” added researchers. “This is a limitation of the study because most beneficiaries take multiple medications, thus total spending would be higher with increasing medication use.”

Coverage of specialty medications was found to range from 10.0% (tildrakizumab) to 99.8% (ustekinumab) across products and Part D plans. For plans that covered these products, a majority (90.5%-100.0%) required prior authorization.

Notably, only 2.4% (risankizumab) to 5.5% (golimumab) of plans offered specialty medications with a co-pay during the initial coverage phase, with most requiring a percentage-based co-insurance for patient cost-sharing. Quantity limits set by health plans were found to range from 1.0% for guselkumab to 75.4% for tofacitinib.

“Medicare beneficiaries needing specialty medications for psoriasis and psoriatic arthritis face very high OOP spending due to rising drug prices and the benefit’s reliance on co-insurance for patient cost-sharing,” said the study authors.

For cost, apremilast and ustekinumab were associated with the lowest and highest costs for each category assessed, respectively:

  • Median point-of-sale price, excluding rebates/discounts, ranged from $3620.40 to $23,492.93 per fill
  • Estimated annual OOP costs ranged from $4423 to $6950
  • Estimated per-fill OOP costs for patients ranged from $1234 to $3426 for their first fill and $181 to $1175 for fills under the catastrophic coverage phase

“Specialty medications for patients with psoriasis and psoriatic arthritis offer improved quality-of-life and better outcomes for patients when used consistently; however, high OOP costs remain a major barrier for Medicare beneficiaries,” they concluded.


Pourali SP, Nshuti L, Dusetzina SB. Out-of-pocket costs of specialty medications for psoriasis and psoriatic arthritis treatment in the Medicare population. JAMA Dermatol. Published online September 15, 2021. doi:10.1001/jamadermatol.2021.3616

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