Access to care
Psoriasis and psoriatic arthritis are serious autoimmune diseases that require lifelong medical care. However, there are thousands of people with psoriasis who are uninsured or have insurance but cannot access the treatment(s) prescribed by their health care provider.
At the National Psoriasis Foundation, we want everyone with psoriasis and psoriatic arthritis to have the care they require to live healthy and productive lives. We are working with health care insurers, government and individuals to end the following harmful insurance policies and procedures, which delay patients' access to relief from painful symptoms:
- Rapidly rising consumer out-of-pocket expenses: In the past decade, responsibility for health care costs has moved from a traditional shared risk model to one where the individual pays a significant portion. Out-of-pocket costs such as co-payments (co-pays), premiums and deductibles are rising at an alarming rate. As a result, 25 percent of Americans report having a "serious problem" paying for basic health care, according to the Kaiser Family Foundation.
- Prior authorization requirements including "step therapy": Prior authorization policies require that the patient go through a complicated process before being approved for a medication or treatment. This includes step therapy, a practice which demands a patient try—and fail—a sequence of treatments before the insurance company will approve the treatment that was originally prescribed. Patients are often required to complete the step therapy process even though the treatment has harsh side effects, or failed to work for the patient in earlier attempts.
- Physician tiering: Some insurance companies "tier," or categorize, physicians based on the cost of the medications they prescribe rather than the quality of the care they deliver. When a physician is "tiered," a patient is forced to choose between paying more out-of-pocket to see that provider or go to a insurance company "preferred" physician who may not have the same understanding about treating psoriatic diseases.
- Health care rationing: Many psoriasis patients have their insurance coverage rationed when the company decides to cover a particular treatment or medication for a set time, such as six months or one year. Rationing occurs even if a patient's disease is chronic and has symptoms that require ongoing treatment. Insurance companies will also ration health care by requiring patients to have the disease symptoms for a period of time before prescribed medications are approved for use.
- Defining specialty drugs as "tier four": A growing trend among insurance companies is to place specialty drugs, such as the biologic drugs used to treat psoriasis and psoriatic arthritis, into a higher drug formulary category under which higher payments are required. These specialty drugs are can be the most effective treatment for moderate to severe psoriasis; however, patients are charged more out-of-pocket to access them.
We need your help to challenge these complicated health insurance policies and procedures. Join the Psoriasis Action Network and fight for your right to access the care you need, when you need it.
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