Psoriasis and the Oregon Health Plan
From September/October 2006 Psoriasis Advance
Several years ago, Oregon Health & Science University (OHSU) and the National Psoriasis Foundation began advocating for Medicaid patients in Oregon. At that time, psoriasis was not covered at all under the Oregon Health Plan (OHP), Oregon's Medicaid program.
Today, thanks to advocacy efforts and effective collaboration, OHP covers psoriasis and has extended the coverage that psoriasis patients receive under the plan.
The background
Like most other state-aided programs around the country, OHP has to divide a small pie among many pressing areas. And like other programs, OHP is serving the uninsured population. The National Psoriasis Foundation became involved on behalf of these patients and to establish a precedent of change for other state plans around the country. The Oregon case is also important because private insurers watch the public sector (Medicaid and Medicare) for ways to manage health care and then often follow suit.
In 2002, Eric Simpson, M.D., assistant professor of dermatology at OHSU, and consultant for OHSU's Center of Excellence for Psoriasis and Psoriatic Arthritis, took the lead and testified in favor of basic coverage for severe psoriasis at a time when psoriasis treatment was not covered by OHP.
Because of Dr. Simpson's testimony, the Oregon Health Plan set out to review the policy as part of its ongoing public process. The Psoriasis Foundation worked with OHSU to develop guidelines for psoriasis coverage, submitted letters along with photos and published data, and presented oral testimony at OHP hearings. The Foundation also brought a dermatologist to testify. Bert Tavelli, M.D., effectively conveyed what it is like for a dermatologist to treat psoriasis patients on Medicaid with the limited treatment options available under OHP.
The outcome
Today, OHP's policy covers psoriasis and allows patients with 10 percent body surface coverage or more to be treated (pending final approval at time of writing). Further, people with 10 percent body surface coverage may now qualify for a biologic treatment, and the plan offers a reasonable ladder approach for patients to qualify for these treatments. The policy allows people with psoriasis in areas such as the palms or soles of the feet to qualify for biologics even if other areas of their body are not affected.
"I treat many patients with moderate to severe psoriasis and am witness to the physical and cause," says Dr. Simpson. "My goal was to better inform the decision-makers about the disability that accompanies psoriasis. The Health Services Commission [of the Oregon Health Plan] was very responsive, and I commend them for coming up
with a reasonable compromise—a policy which allows for coverage of psoriasis based on severity."
Patients with mild disease are still not covered by the Oregon Health Plan. From the standpoint of patients and their doctors, this policy is not ideal but is a great improvement.
This experience shows that when patients, medical institutions and physicians bring the same message to a health plan, it works. It is our responsibility as a community to educate the public that psoriasis can be serious and deserves treatment. And when we do, the facts speak for themselves: People listen and change happens.
– Sheila Rittenberg, director of advocacy
| 
