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INSURANCE
COVERAGE FOR BIOLOGICS AND PHOTOTHERAPY FOR
SEVERE PSORIASIS |
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Poster presented at American Academy of Dermatology
56th annual convention, Feb 2-6, 2007
Christopher B. Yelverton, MD, MBA1;
Greg Simpson, MD1;
Steven R. Feldman, MD, PhD1-3
Departments of Dermatology1,
Pathology2,
and Public Health Sciences3,
Wake Forest University Health Sciences, Winston Salem, NC
<read full poster> |
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>
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