The High Cost of Treating Plaque Psoriasis: When Insurance Coverage for Biologics Is a Challenge
Key takeaways:
Treating psoriasis can be costly.
Using job-related health insurance and manufacturer copay savings programs can help with medication costs.
But indirect costs — like gas, travel, and time away from work — can take a financial toll, as well.
My Bill of Health is a series of stories about the financial strain of healthcare. To share your story, email patientstories@goodrx.com.
For Alisha Bridges, job opportunities have always come with the same question: “Will the company’s insurance cover my psoriasis treatments?”
Alisha says that asking that question is key to making sure that she has access to the treatments that work for her condition.
“Sometimes, I have literally not taken a job because they could not tell me whether or not their insurance covered the treatment that I’m currently on,” she says.
A ‘roller coaster ride’ with plaque psoriasis
Since she was young, Alisha developed patches of dry skin on her knees and elbows. But when she contracted chickenpox at age 7, her family discovered there might be a larger issue at hand.
What she thought were scars left behind by the chickenpox were something else entirely. Doctors diagnosed her with plaque psoriasis, an autoimmune skin disorder that causes dry, itchy, raised skin patches called plaques that are sometimes covered with scales. While plaques usually appear on the elbows, knees, lower back, and, in some cases, scalp, they can spread across the body. By the time she was diagnosed, Alisha says, her skin was about 90% covered in these rashes.
“From the time I was 7, up until around 27 years old, I have been covered with severe plaque psoriasis,” Alisha says. “The challenges have kind of varied depending on my age and circumstances. When you’re younger, there’s a limit to the treatments that you can use. Then, when you get older, you have to face a lot of insurance challenges. It’s definitely been a roller-coaster ride with this condition.”
At first, her doctors recommended topical treatments. Then, she tried phototherapy. Phototherapy — also called light therapy — involves exposing the skin to certain types of ultraviolet (UV) light. The goal is to reduce inflammation, slow down skin cell growth, and improve the appearance of skin. But, like other treatments, it never seemed to work for Alisha.
“It never made a difference,” she says. “But, when you're desperate for change, there’s always a hope there that maybe, one day, this treatment will help.”
Alisha lost insurance coverage during college, so she hit pause on treating her psoriasis. After getting her first job, she restarted treatment. And at that point, her doctors put her on biologics, medications that target the immune system. She says that that’s when she started to see positive results.
Biologics bring relief — but with a hefty price tag
Alisha now takes the injectable medication Skyrizi (risankizumab) and has seen most of her plaque psoriasis disappear.
But, she says, the happiness that comes with having some relief from the plaques always feels temporary.
“I was looking forward to going shopping and doing different things that I love to do, without the stress and the anxiety of people seeing my skin — or having to explain it to others. That was a big relief,” Alisha says. “But it doesn’t feel permanent. It never feels permanent.”
She adds, “That’s one of the things that I try to explain to people. Without a cure, you’re always going to have to deal with psoriasis — even when you have an effective medicine — because it comes back.”
One of the biologics she took before Skyrizi worked for a few years, but then stopped being as effective, Alisha points out.
A manufacturer copay savings program helps her afford medications
Sometimes, Alisha says, issues with her insurance are as much of a problem as her symptoms.
“You can lose your treatment because of insurance issues,” she says. “Recently, the insurance I used covered it, but I still had a $5,000 copay. I had to sign up for a copay savings program, which covered it. But then, the money from the copay program ran out. I had to get into another [type of] program at work.”
Alisha says, in the past, she’s spent between $50 and $300 a month on treatments. Now, with better health insurance coverage taking care of many of the upfront costs, she pays less. But that doesn’t cover hidden expenses like travel and time away from work.
When she was a child, Alisha and her grandparents, who raised her, would travel to phototherapy appointments.
“My grandma would have to take me to the hospital three to four times a week,” she says. “The hospital is 40 minutes away. That’s hundreds of dollars in gas every week. That’s time out of your schedule; that’s time off of work. So it’s not just the impact of the cost of the medicine, but it’s the residual things around it, as well.”
The cost of her treatments also meant that Alisha missed out on certain opportunities.
“I remember having to come home in the summertime, as opposed to sometimes being able to get a summer job,” she says. “I was in the hospital for 3 weeks doing an extensive treatment for my psoriasis, which included phototherapy. It’s time. It’s money. It’s very costly from every angle.”
Patient advocacy groups offer support
Alisha found help through patient advocacy groups like the National Psoriasis Foundation and the Global Health Living Foundation. These groups help people learn about their chronic conditions and provide resources for managing costs.
Alisha is now a copywriter and ambassador for the Global Healthy Living Foundation’s Salon HEROES program. The program helps beauty professionals understand clients with scalp and skin conditions. Working with the HEROES program helps her not only teach others how to interact with psoriasis patients, but to look on the upside of things. Alisha says she knows her plaque psoriasis could come back, but she’s working every day to look at the positives in her life.
Dealing with plaque psoriasis returning “is definitely a worry that I have,” Alisha says. “But I’m also a very centered and meditative person. I tend to try to just focus on ‘the now.’ Right now, I’m good.”
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