Learned Christine, Alsukait Sara, Fiumara Kristin R, Ortega Melissa, Chambers James D, Rosmarin David
Department of Dermatology, Tufts Medical Center, Boston, MA, USA.
Department of Pharmacy, Tufts Medical Center, Boston, MA, USA.
J Psoriasis Psoriatic Arthritis. 2022 Oct;7(4):160-163. doi: 10.1177/24755303221101843. Epub 2022 May 15.
Specialty medications provide effective treatment with limited adverse effects to patients with psoriasis and psoriatic arthritis; however, variable coverage and high costs often create a barrier to treatment for patients with commercial health insurance.
We aimed to evaluate coverage of psoriasis and psoriatic arthritis specialty medications by commercial insurance companies.
We compiled data regarding specialty drug coverage for psoriasis and psoriatic arthritis using Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) database and analyzed the data for any notable trends. The SPEC database lists coverage decisions for 158 specialty drugs by 17 of the largest US commercial health plans, as well as data regarding the types of evidence cited by these insurance plans when making coverage decisions.
Our results showed that insurance plans tend to be more restrictive than the U.S. Food and Drug Association (FDA) label when covering medications for psoriasis and psoriatic arthritis. Furthermore, medications for psoriatic arthritis tended to be less restricted than for psoriasis, and medications were most commonly approved as second line agents for both indications.
Our analysis confirms that variability in insurance coverage exists for the indications of psoriasis and psoriatic arthritis.
专科药物为银屑病和银屑病关节炎患者提供了有效的治疗，且副作用有限；然而，保险覆盖范围的差异和高昂的费用常常给商业医疗保险患者的治疗造成障碍。
我们旨在评估商业保险公司对银屑病和银屑病关节炎专科药物的覆盖情况。
我们使用塔夫茨医学中心专科药物证据与覆盖（SPEC）数据库汇编了有关银屑病和银屑病关节炎专科药物覆盖的数据，并分析了数据中任何显著趋势。SPEC数据库列出了美国17家最大的商业健康保险计划对158种专科药物的覆盖决定，以及这些保险计划在做出覆盖决定时所引用的证据类型的数据。
我们的结果表明，在覆盖银屑病和银屑病关节炎药物方面，保险计划往往比美国食品药品监督管理局（FDA）的标签限制更严格。此外，银屑病关节炎药物的限制往往比银屑病药物少，两种适应症的药物最常被批准作为二线药物。
我们的分析证实，银屑病和银屑病关节炎适应症的保险覆盖存在差异。
