INTRODUCTION: Insurance companies vary widely in their coverage policies for severe psoriasis therapies and the range of treatment options may fall under multiple portions of a patient’s health benefits package (medical, pharmacy, durable medical equipment) with some options not being covered at all.  These variations in coverage options may be a significant hindrance to the selection of an ideal treatment plan than other well-studied, less-expensive options.

METHODS:  We reviewed insurance policy bulletins, statements of coverage/medical necessity, and prior authorization forms for three large insurance carriers regarding psoriasis treatment with biologic agents and phototherapy. Specific attention was placed on body surface area requirements and need for prior treatment failures.

Discussion: We looked at 3 large insurance carriers’ (Aetna, Cigna, and BCBS of California) coverage for biologics and phototherapy. While it may seem intuitive that disease coverage of larger body surface areas would be warranted for phototherapy, as it treats large areas, such requirements may be detrimental to both patients and insurers. Given that there are several phototherapy devices specifically designed for smaller area treatments, and that phototherapy is significantly less costly than biologics, these policies are neither medically nor financially viable. Likewise, requirement for demonstrated efficacy of office-based phototherapy prior to prescription may take several sessions. Given that a single month’s supply of a typical biologic exceeds the cost of a standard home phototherapy unit, this restriction is not justified.  <read full poster>

Learn more about our unique contracting opportunities. 
Contact us