Coverage of Specialty Drugs for Psoriasis and Psoriatic Arthritis by Commercial Insurance Companies.

Background: Specialty medications provide effective treatment with limited adverse effects to patients with psoriasis and psoriatic arthritis; however, variable coverage and high costs often create a barrier to treatment for patients with commercial health insurance.

Objective: We aimed to evaluate coverage of psoriasis and psoriatic arthritis specialty medications by commercial insurance companies.

Methods: We compiled data regarding specialty drug coverage for psoriasis and psoriatic arthritis using Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) database and analyzed the data for any notable trends. The SPEC database lists coverage decisions for 158 specialty drugs by 17 of the largest US commercial health plans, as well as data regarding the types of evidence cited by these insurance plans when making coverage decisions.

Results: Our results showed that insurance plans tend to be more restrictive than the U.S. Food and Drug Association (FDA) label when covering medications for psoriasis and psoriatic arthritis. Furthermore, medications for psoriatic arthritis tended to be less restricted than for psoriasis, and medications were most commonly approved as second line agents for both indications.

Conclusion: Our analysis confirms that variability in insurance coverage exists for the indications of psoriasis and psoriatic arthritis.