What Psoriasis Treatments Does Medicare Cover? Biologics and More

Psoriasis is an autoimmune skin condition that can cause rashes anywhere on the body. More than 7.5 million adults and children in the U.S. live with one of the five kinds of psoriasis. The most common kind is plaque psoriasis.

About one-third of people with psoriasis also develop psoriatic arthritis (PsA). This causes inflammation in the joints, spine, and tendons. People can develop PsA without having psoriasis.

Psoriasis can occur at any age. But most people develop the condition during “onset peaks” — in their teens and early 20s or in their late 50s.

Since there’s no cure for psoriasis, you manage this condition for the rest of your life. Symptoms of psoriasis can include:

• Burning

• Cracked skin

• Itching

• Pain

• Swelling

Many Medicare enrollees need treatment for psoriasis. So it’s important to know if treatment is covered by original Medicare, Medicare Advantage, and Medicare Part D.

What are the most common treatments for psoriasis?

Psoriasis is treated with a variety of therapies. Your healthcare professional will choose the options most likely to ease your symptoms and improve your quality of life. Most care plans include one or more of these treatments:

• Oral medications: These include pills and liquids that treat psoriasis and psoriatic arthritis.

• Topical treatments: Topical psoriasis treatments include creams, moisturizers, and ointments that are available by prescription and over the counter.

• Biologics: Biologics are complex medications derived from living sources. They can have more affordable versions known as biosimilars. They are typically administered via intravenous (IV) infusion or under-the-skin (subcutaneous) injection. They aren’t typically first-choice treatments. They are reserved for moderate and severe cases when other medications aren’t working well.

• Phototherapy: Known as light therapy, this treatment uses wavelengths of light to slow the growth of overactive skin cells. It may be administered in a healthcare setting or at home.

Which psoriasis treatments does Medicare cover?

Medicare reimburses many costs related to psoriasis treatment. These include appointments with your primary care doctor and specialists as well as certain medications. Here’s how different parts of Medicare cover psoriasis therapy:

• Medicare Part B: Part of original Medicare, Part B covers visits with healthcare professionals, lab tests, X-rays, scans, some preventive services, and certain durable medical equipment.

• Medicare Part C: Known as Medicare Advantage, this is an alternative private plan that replaces Medicare Part A and Part B.

• Medicare Part D: This covers prescription drugs and treatments. These include topicals, oral medications, and biologics. Part D is a standalone plan with original Medicare. It is typically included with a Medicare Advantage plan.

EXPERT PICKS: WHAT TO READ NEXT

• Psoriasis doesn’t look the same on everyone. These pictures show how psoriasis rashes can look different depending on your skin tone and the area of the body.

• The best way to manage psoriasis is good skin care. Gentle skin care products, getting sun or light therapy, and maintaining moisture can all help with psoriasis care.

• Have scalp psoriasis? Your topical treatment options include prescription and over-the-counter creams, ointments, and shampoos.

Review your plan benefits to see which treatment and services are covered.

Oral medications

Most Part D plans cover oral medications. Check your plan’s formulary to verify that yours is on the list.

This table includes some of the oral medications that treat psoriasis.

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This is not a complete list of oral medications that treat psoriasis and PsA.

Topical medications

Topical treatments help ease the cracking, burning, and itching of psoriasis. Medicare Part D plans cover many of these medications, but always confirm with your formulary.

This table lists a few commonly prescribed topical options.

This is not a complete list of topical medications that treat psoriasis and PsA.

Biologics

Part B or Part D may cover biologic treatments for psoriasis. These include biosimilars, which are very much like their reference biologic. Some Medicare Advantage plans may also cover certain services.

• IV infusions: Part B covers outpatient treatments. At-home IV treatments are also covered. Your infusion pump is probably covered by Part B as durable medical equipment.

• Injectable treatments: Part B covers injectable biologic treatments administered by a healthcare professional. If you’re prescribed an under-the-skin injection pen to administer the drug yourself, Part D covers this.

For instance, Remicade (infliximab) is a monthly infusion administered by a healthcare professional. Your Medicare plan may cover this medication or one of its biosimilars.

This is not a complete list of biologics that treat psoriasis and PsA.

Phototherapy (light therapy)

Original Medicare and Medicare Advantage cover light therapy if you have a psoriasis diagnosis and an order for phototherapy. Medicare Part A covers care provided in a hospital. Part B covers outpatient and at-home therapy.

Does Medicare cover over-the-counter psoriasis treatments?

Original Medicare does not cover over-the-counter (OTC) medications. But research by the Consumer Healthcare Products Association found that in 2021, 80% of Medicare Advantage plans paid for these items through their OTC benefits perk. There is usually a preloaded payment card associated with your account. It has a dollar amount you can spend monthly, quarterly, or annually. You can use it at retail outlets. Your Medicare Advantage plan may help you pay for:

• 1% hydrocortisone cream for itching and swelling

• Popular pain relievers like ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol)

• Anti-inflammatory topicals, including diclofenac (Voltaren), capsaicin, and menthol creams

What psoriasis treatments are not covered by Medicare?

Coverage depends on your Medicare plan. For instance, OTC supplements may not be covered. That’s why it’s critical to review your plan’s summary of coverage and benefits.

What out-of-pocket costs are you responsible for if you have Medicare?

People with original Medicare spent more than $6,600 annually on out-of-pocket costs in 2019. Your expenses will depend on your coverage and healthcare needs. If you have original Medicare, a Medigap supplement insurance plan can help you with your out-of-pocket costs.

How to save on psoriasis treatment

Because many treatments are new and highly effective medications, they carry high prices. Here are six ways to decrease or offset the expense of psoriasis care.

1. Enroll in a patient assistance program. Most manufacturers of brand-name prescription drugs offer these programs. They help uninsured or underinsured people who meet eligibility requirements. For instance, Janssen CarePath offers a patient assistance program. People can enroll if they receive Remicade infusions  but are uninsured or covered by a commercial insurance plan.

2. Get a copay savings card. If you have commercial insurance, you may be eligible for a savings card from manufacturers. With this card, you pay less (and sometimes nothing) for costly medications like Otezla. Many pharmaceutical makers also offer direct discounts on high-cost medications.

3. Seek an exception. You may qualify for two kinds of exceptions. A tiering exception can reduce your copay for a high-tier medication. This is because those treatments have higher cost sharing. Unless your medication is in a specialty tier, you can ask for cost sharing for a lower tier. You can also request a lower-cost medication that’s not on your plan’s formulary.

4. Ask for a biosimilar if available. These medications can cost more than 50% less than their brand-name counterparts. Biosimilars saved U.S. consumers more than $9 billion in 2022.

5. Access free and low-cost insurance and healthcare. You may qualify for free or low-cost health insurance or a plan subsidy on the Affordable Care Act marketplace.

6. Choose GoodRx.You can’t use GoodRx with Medicare Part D. But it can make sense to use a GoodRx coupon when Medicare doesn’t cover your medication. It’s also a good call when you won’t reach your annual deductible or the GoodRx price is less than your Medicare prescription plan copay.

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Written by:

Margot Lester

Margot Lester is an award-winning journalist and author with over 30 years of experience. Her work has appeared in magazines, newspapers, and journals.

Edited by:

Cindy George, MPH

Cindy George, MPH, is the senior personal finance editor at GoodRx. She is an endlessly curious health journalist and digital storyteller.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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