Marquez-Grap Georgia, Pham Dayna L, Leung Andrea, Leeolou Melissa C, Kranyak Allison, Liao Wilson
Department of Dermatology, University of California, San Francisco, Room N414, 2340 Sutter Street, San Francisco, CA, 94115, USA.
Patient Author, Chicago, IL, USA.
Dermatol Ther (Heidelb). 2025 May 3. doi: 10.1007/s13555-025-01430-1.
The management of psoriatic disease has been revolutionized by biologic medications in recent years. Despite their efficacy and safety, patients are often required by insurance plans in the USA or national formulary guidelines in other countries to try and fail other treatments first, which is a strategy called step therapy. Originally designed to contain costs of specialty drugs, step therapy has a number of negative impacts on patients and providers, both personally and clinically. This article is coauthored by a patient with psoriasis and psoriatic arthritis who navigated step therapy. She describes her early experiences with psoriasis and achieving disease control with biologic medication, only to later be diagnosed with psoriatic arthritis and need to revise this treatment plan. She then explains how insurance denials and step therapy impact her life physically, emotionally, socially, and medically. This case is then discussed from the perspective of a dermatologist specializing in inflammatory skin disease. We highlight the psychosocial burden of psoriatic disease, as well as the burden of step therapy and its impacts on patients, providers, and the entire medical system.
近年来，生物药物彻底改变了银屑病的治疗方式。尽管这些药物疗效显著且安全性高，但在美国，保险计划通常要求患者，在其他国家，国家处方指南也常常要求患者，先尝试其他治疗方法并失败后，才能使用生物药物，这一策略被称为阶梯治疗。阶梯治疗最初旨在控制专科药物成本，但对患者和医疗服务提供者在个人层面和临床方面都产生了诸多负面影响。本文由一位经历过阶梯治疗的银屑病和银屑病关节炎患者共同撰写。她描述了自己早期患银屑病的经历以及通过生物药物实现疾病控制的过程，然而后来被诊断出患有银屑病关节炎，需要修改治疗方案。她接着解释了保险拒付和阶梯治疗如何在身体、情感、社交和医疗方面对她的生活产生影响。随后，一位专门研究炎症性皮肤病的皮肤科医生对这个案例进行了讨论。我们强调了银屑病的心理社会负担，以及阶梯治疗的负担及其对患者、医疗服务提供者和整个医疗系统的影响。
