August is national psoriasis awareness month. Psoriasis is the most prevalent autoimmune disease in the U.S., affecting as many as 7.5 million Americans. While most people associate psoriasis with its physical symptoms – painful red, scaly patches that bleed and often cover patients from head-to-toe – most are unaware about another symptom – this one affecting patients’ wallets.
Some of the most effective and life-improving treatments for patients with psoriasis are newer, costlier biologic medications. Years of scientific research and innovation have yielded biologic treatments that are life-changing for patients with psoriasis. I’ve witnessed first-hand those scales and patches disappear as a result of biologic treatments, greatly improving not only a patient’s medical condition, but also quality of life.
But insurance policies, coverage determinations and out-of-pocket expenses put these treatments out-of-reach for many patients. For some of the new treatments, the course of one year of therapy can exceed $50,000. Finding out you have a chronic condition is one thing, but the real blow can be discovering how expensive these medications really are.
To choose a cheaper drug option is often to choose a drug that just isn’t as effective or has more side effects. According to one pharmacy benefit manager, even though only 2 percent of the population uses biologic drugs, biologics account for 40 percent of prescription drug spending in the U.S., contributing to a national economic burden of psoriasis that, by a conservative estimate, approaches $50 billion per year.
Biologics are considered specialty drugs, and insurance companies are shifting the cost-sharing burden for these treatments to patients. Rather than charging fixed co-pays, specialty tiers require patients to pay a percentage of the cost of their drugs, as high as 50 percent in some cases. These practices are placing medically necessary treatments out of reach of average Americans. Monthly co-insurance amounts can cost thousands of dollars. Individuals unable to afford specialty tier pricing are likely to go without crucial medications, resulting in disability and other expensive health complications, further exacerbating the cost of health care.
However, a first step to help ease this burden is within our reach. When Congress returns to Washington in a few weeks, they must act immediately to help our nation’s patients. The Patients’ Access to Treatment Act of 2015 is an important step to help ease financial burdens for patients. If passed, the bill would limit cost-sharing requirements for specialty medications, making these treatments more accessible by reducing patients’ out-of-pocket expenses.
Dozens of national patient and provider groups support the legislation. While it will take more than one piece of legislation to address our nation’s drug pricing crisis, this bill begins to address the issue for those to whom the issue is most important – our patients.
It’s time to stop the finger pointing in the debate over the cost of medications and time to start acting. Biologics are used to treat not only psoriasis, but hundreds of debilitating disease including cancer, multiple sclerosis, cardiovascular disease, diabetes, arthritis and more. We can and must do better for our patients.
Mark G. Lebwohl, MD, FAAD, is President of the American Academy of Dermatology.