Improving Management of Patients with Psoriasis to Reduce Costs

Steven R Feldman, MD, PhD, professor of dermatology at the Psoriasis Treatment Center at Wake Forest University School of Medicine, discussed how to improve treatment adherence and outcomes in patients with psoriasis at the NAMCP 2017 Spring Managed Care Forum. 

Dr Feldman stated that the objective of his presentation was to “discuss emerging options or new treatment targets in patients who do not respond to traditional therapies,” and to “Explore the burden of psoriasis and the impact that undertreatment and nonadherence have on comorbidities, quality of life, and productivity.” 

He started his presentation by explaining that psoriasis impacts both mental and physical quality of life as much as most other chronic diseases, such as diabetes and depression. 

Dr Feldman showed that the American Academy of Dermatology guidelines recommend topicals for limited disease and systemic and biologic treatments for extensive disease. The guidelines also recommend anti-TNF inhibitors if psoriasis patients also have psoriatic arthritis. 

Dr Feldman noted that lack of adherence plays a significant role in patient outcomes for psoriasis treatment. 

“We have treatments that are remarkably effective,” Dr Feldman wrote. “Patients don’t always get better… Do we need new treatments or just new ways to get patients to use the existing (often generic) treatment?”

He cited evidence showing that in an anonymous survey, 40% of psoriasis patients reported noncompliance to their treatment regimens. He added that most psoriasis patients do not even fill their prescriptions and are among the worst nonadherers of all dermatologic disease states.

Dr Feldman listed the primary factors motivating nonadherence, which included poor motivation, secondary gain, lack of trust in their provider, fear of medications, forgetfulness, resignation, and more. 

In order to combat this issue, Dr Feldman suggested that providers need to establish a relationship with patients by involving patients in treatment planning, choosing fast-acting agents, and giving clear written instructions.

Dr Feldman pointed out that treatment regimens need to be simplified. He also explained that for psoriasis patients with limited disease, less messy topical ointments are more likely to have high adherence rates. 

He also noted that copays can help improve adherence, but sometimes can result in a zero sum equation. 

“If patients have paid a copay, they will use the medication,” he said in the presentation. “On the other hand, if the copay is too high, they are less likely to fill the medication.” 

Dr Feldman concluded that by stating that “New treatments (biologics) have been revolutionary,” but “poor adherence is still a major limitation to treatment.”—David Costill