Specialty Pharmacy Trends Report: Psoriasis/Psoriatic Arthritis

Psoriasis is an autoimmune disease in which excessive skin cell growth results in thick, discolored patches of skin. Some individuals with psoriasis may also develop psoriatic arthritis (PsA), in which the immune system attacks the joints, causing inflammation. According to the National Psoriasis Foundation, approximately 7.5 million Americans have psoriasis and 125 million people worldwide are affected. Between 10% and 30% of people with psoriasis will develop PsA.

The annual healthcare cost, including direct and indirect costs, for patients with psoriasis in the United States is approximately $11.25 billion, with work loss accounting for 40% of those costs. For individuals with PsA, the direct healthcare costs are estimated to be $1.9 billion. In addition to topical treatments and oral medications, psoriasis and PsA may be treated with biologics in the form of injections or intravenous infusion. Psoriasis may also be treated with phototherapy, in which the skin is exposed to ultraviolet light on a regular basis under medical supervision.
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When the survey participants were asked if they are involved in reporting adherence and/or compliance on the use of psoriasis and PsA medications obtained through specialty pharmacy, 37.04% said “never,” while 22.22% said they are involved “a moderate amount” (Figure 1).

Respondents to the survey were asked what percentage of specialty pharmaceuticals for treatment of psoriasis and PsA require in-office administration of the drug, and 53.7% of respondents said 0% to 25% and 29.63% said they were unsure (Figure 2).

The majority of survey participants (62.96%) said they “always” provide patients with safety information to supplement prescribing information in regard to the use of biologics, although 24.07% said it depends on the prescription (Figure 3).

Specialty pharmacy is a burgeoning field that continues to be of importance for managed care professionals. With the rates of chronic, high-cost conditions increasing, payers are eager to find ways to diffuse costs, while also providing patients with the best care possible. First Report Managed Care partnered with the National Association of Specialty Pharmacy to put together this Specialty Pharmacy Trends Report.

The information for this trends report was generated through a comprehensive survey developed via the collaborative efforts of an Advisory Panel of key thought leaders and the First Report Managed
Care editorial staff. This survey was then sent to a diverse pool of specialty pharmacy professionals. This is part 3 of a 3-part series we bring to you on the climate of specialty pharmacy as it relates to the managed markets. We hope that you find the information presented to be practical, informative, and compelling. We hope the survey results serve as a resource you can use in making future management decisions.

Survey Participant Demographics

Key thought leaders in the field of specialty pharmacy have provided the information collected in this Specialty Pharmacy Trends Report series. The following are the demographic responses, providing a snapshot of the survey participants and the organizations for which they are affiliated.

The Northeast is home to most of the survey participants (33.93%), while 28.57% of participants are in the Midwest, 10.71% in the Southeast, 10.71% in the Pacific, 10.7% in National regions, 3.57% in the Mountain region, and 1.79% said “not applicable.”

The majority of the survey respondents (60.71%) have a PharmD degree, while 39.29% have a BS in
Pharmacy, 17.86% have an MBA, 10.71% have an MS, and 5.36% have a PhD. A significant majority of survey participants (53.57%) have an RPh certification, while 17.86% have a BCPS, and 12.5% have a CSP.

When asked how long they have been in the specialty pharmacy field, 35.71% of survey participants said 0 to 5 years, while 28.57% said 11 to 20 years, and 26.79% said 6 to 10 years.

Mail-order specialty pharmacy is the primary facility of work for 23.21% of the survey participants. An additional 16.07% said their primary facility of work is an academic institution (not a university hospital), another 16.07% said a managed care organization, 14.29% said a retail specialty pharmacy,
and 10.71% said a consulting firm.

When asked what type of specialty pharmacy they are involved with, 26.79% of the survey respondents said independently owned (nonretail) and another 26.79% said pharmacy benefits manager. Another 16.07% of the survey respondents are involved with a health plan-owned specialty pharmacy and 14.29% are retail pharmacy owned.

Most of the survey respondents (39.29%) reported that they have 1% to 25% of patient interaction time on a monthly basis, while 28.57% said their role does not currently involve patient interaction.

When the survey participants were asked to select the top 5 therapeutic categories with which they are most involved, and with the option to select up to 5 areas, the results were the following:
     • Oncology (69.64%)
     • Rheumatoid arthritis (67.86%)
     • Hepatitis C (64.29%)
     • Multiple sclerosis (50%)
     • Diabetes (37.5%)
     • Crohn’s disease (35.71%)
     • Psoriasis/Psoriatic arthritis (35.71%)
     • HIV/AIDS (25%)
     • Hemophilia (23.21%)
     • Immunoglobulins (12.5%)
     • Cystic fibrosis (8.93%)
     • Hereditary angioedema (5.36%)
     • Gout (3.57%)
     • Infertility (1.79%)