What Does It Cost to Treat Psoriatic Arthritis (PsA)?
Key takeaways:
Psoriatic arthritis is an autoimmune condition that causes pain and inflammation in a person’s skin, joints, tendons, and spine.
The cost of treatment for psoriatic arthritis can range from inexpensive pills to costly injections and infusions.
You can save on psoriatic arthritis treatment by having health insurance, enrolling in a patient assistance program, or by using GoodRx.
Psoriatic arthritis (PsA) is an autoimmune condition that causes pain and inflammation in a person’s skin, joints, tendons, and spine. About 1 to 2 people in 1,000 have PsA. This is 0.1% to 0.2% of the population, including some children. Over time, the condition can cause joint damage. About 20% to 30% of people who have psoriasis will develop psoriatic arthritis. It’s also possible to have PsA without psoriasis.
There is no cure for psoriatic arthritis, but medications can help improve a person’s quality of life. Treatment may include oral medications, injections, infusions, and alternative therapies. Costs can range from inexpensive prescription tablets to pricey injections and infusions.
Maintaining a healthy life will likely include exercise, a healthy diet, limited stress, and adequate rest. The costs of treatment may go beyond medication to include expenses for a gym membership, massage therapy, or acupuncture.
What are the out-of-pocket costs for psoriatic arthritis treatment?
Out-of-pocket costs vary for psoriatic arthritis treatment. A recent study found that a Medicare’s enrollee’s out-of-pocket cost for one year of specialty medication to treat psoriasis or psoriatic arthritis could be more than $6,900.
Methotrexate is an inexpensive prescription medication available as a tablet or injection. This generic drug is covered by most insurance plans. With a GoodRx coupon, you could pay as little as $14 — or even less.
There are several specialty medications for psoriatic arthritis that are much more expensive. Enbrel is a biologic medication that can be self-injected once a week. This medication is only available as a brand name and will likely have a higher copay on insurance plans. Without insurance or discounts, Enbrel can cost more than $11,000. With GoodRx, you may pay more than $6,000 for a carton of 4 cartridges.
Enbrel’s manufacturer offers a copay card for commercially insured patients that can drop your out-of-pocket costs to as little as $5. (If you have Medicare, Medicaid, or any other government insurance, you cannot use the copay card program.) There are also several patient assistance programs that help qualified applicants with Enbrel costs.
Does insurance cover psoriatic arthritis treatment?
Yes. These insurance plans may cover your psoriatic arthritis treatment:
Original Medicare: Medicare covers much of the cost of PsA care. This includes appointments with specialists, biologic medications, and other prescription drugs. Medicare will cover physical therapy, occupational therapy, and, in some cases, home health services. Medicare only covers acupuncture for chronic low-back pain. Medicare does not cover massage therapy.
Medicare Advantage: Medicare Advantage plans may provide more coverage than original Medicare. Known as Medicare Part C, these private plans could include benefits that will help your condition, such as a gym membership and transportation to doctor visits.
Medicaid: Medicaid is a federal program operated by each state. All states currently provide prescription drug coverage. Federal law requires Medicaid programs to provide certain benefits including physician services and transportation to medical care. Programs have the option to include benefits such as physical therapy.
Medigap: Medigap is private, supplemental insurance that can help pay for out-of-pocket costs not covered by a primary insurance plan. These expenses include copayments, coinsurance, and deductibles.
Private insurance plans: Many private insurance plans cover psoriatic arthritis. Check your specific benefits for details about the care, services, and treatments included.
Social Security: Social Security Disability Insurance (SSDI) provides coverage for people who document a psoriatic arthritis case that affects their ability to work.
Critical illness insurance: Critical illness insurance provides supplemental coverage for certain serious or life-threatening emergency conditions. Typically, PsA is not covered by many critical illness insurance policies. Some plans providing broader coverage may cover psoriatic arthritis.
Can you pay for psoriatic arthritis treatment with a flexible spending account?
Yes. You can use a flexible spending account (FSA) to cover out-of-pocket medical expenses for your psoriatic arthritis, tax-free. This includes deductibles, copays, and prescription medications.
Other qualified expenses that may contribute to your PsA treatment include massage therapy and acupuncture.
What are some other psoriatic arthritis treatment costs?
As mentioned earlier, prescription medications help people manage psoriatic arthritis. However, your costs for managing PsA may go beyond a pill, injection, or infusion.
You may seek out complementary or alternative treatment, such as acupuncture or massage. This might be covered by your insurance, but you will likely pay some or all costs out of pocket.
Because psoriatic arthritis is a chronic condition, you may need surgery or assistive devices. Having a PsA flare, or a temporary worsening of symptoms, may cause you to lose time from work. Time off work may cost you income.
Having an illness that causes pain may mean that you need mental health therapy such as counseling. Complications from PsA also can lead to other conditions and extra costs.
Let’s explore costs over several treatment areas, starting with prescription drugs:
Methotrexate, a generic tablet, was discussed earlier as an affordable oral medication. Name-brand pills, such as Xeljanz, can exceed $2,000. You may benefit from manufacturer savings cards and patient assistance programs to reduce your out-of-pocket costs.
Enbrel, also mentioned before, is a biologic medication that can be self-injected. Other injectable biologics, including Humira and Cosentyx, can cost thousands of dollars.
Drugs including Remicade must be infused through a vein, so these treatments are usually given at a medical office or infusion center. This therapy typically costs several thousand dollars each time. This cost can be offset by insurance, manufacturer coupons, and patient assistance programs.
Now, let’s talk about alternative treatment.
Some people may use acupuncture or massage therapy to treat psoriatic arthritis. The cost of acupuncture treatment can range from $75 to $200 per session, according to the Arthritis Foundation.
Some insurance plans cover acupuncture treatment and massage. Medicare only covers acupuncture for chronic low-back pain and does not cover massage therapy. Check with your plan to see if alternative therapy is included in your benefits.
Beyond medication and physical treatment for your PsA, you might need surgery at some point. Keep the possibility of surgery — with all of its potential costs — in mind as you are managing psoriatic arthritis.
You might want to consult our advice on anticipating upfront costs to help you plan for the future.
How to save on psoriatic arthritis treatment costs
You may be able to save on prescriptions with manufacturer discounts and patient assistance programs, as mentioned above.
Check our tips for accessing free and low-cost healthcare for more advice on how to save money on PsA costs.
You may qualify for Medicaid or a subsidy for a private insurance plan through the Affordable Care Act marketplace.
You also may be able to find free and low-cost services through federal qualified health centers as well as safety-net hospitals and clinics.
The bottom line
Psoriatic arthritis is a condition that usually requires treatment. Think ahead about the costs to manage PsA. In addition to medications, you may need surgery, counseling, and assistive devices to manage your condition. There are many ways to save on PsA treatment, including drug-manufacturer discounts and patient assistance programs. You may also be able to find free or low-cost care in your community.
Why trust our experts?
References
Arthritis Foundation. (n.d.). Acupuncture for arthritis.
Medicaid.gov. (n.d.). Prescription drugs.
Medicare.gov. (n.d.). Acupuncture.
Medicare.gov. (n.d.). Massage therapy.
Orenstein, B. W. (2021). Managing chronic pain and fatigue. National Psoriasis Foundation.
Pourali, S. P., et al. (2021). Out-of-pocket costs of specialty medications for psoriasis and psoriatic arthritis treatment in the Medicare population. JAMA Dermatology.
