Fits and Restarts

Austin Tolchin thought the flaking and itching on his scalp was dandruff. He tried a number of shampoos with no relief and no improvement. But he was able to put the problem out of his mind for the most part, with plenty of other distractions in his life. Tolchin works at a fast-paced job in finance in the Washington, D.C., area, where the native of Miami, Florida, had landed while getting his master’s degree in finance at Georgetown University.

“I started developing an itchy scalp. I'd be at work, itching and seeing all these flakes all over me,” he recalls. “I'm like, ‘What is going on here?’ It was weird.”

These first signs of what turned out to be psoriasis showed up around 2018. Tolchin did not immediately connect the lesion that soon developed on his leg with the scalp symptoms he was experiencing. It was not until lesions spread to several other parts of his body that he sought out a dermatologist and got the right diagnosis.

With the COVID-19 pandemic in full swing by then, and because he grew up in Florida and was newer to Washington, D.C., Tolchin saw a Florida-based dermatologist via video – also known as telehealth, a practice many have become familiar with as a result of the pandemic. The dermatologist got him started on a biologic treatment. Tolchin was concerned, however, because his dermatologist said his insurance would likely not cover the biologic unless he had tried and failed several other treatments first. This is known as step therapy, which the National Psoriasis Foundation (NPF) works to address through state and federal advocacy efforts.

Because of the pandemic, Tolchin and his dermatologist also worried about the impact of other systemic treatments on his immune system. So he settled on trying out the biologic samples from what he referred to as a “starter pack” from his dermatologist. The biologic worked. Although flares came and went, the treatment helped him gain some control, and the body surface area coverage of the lesions lessened.

“I was pretty clear for a couple months,” Tolchin says. “But insurance still hadn’t covered [the biologic] for me, so I ran out.” That’s when things went from bad to worse for Tolchin. Florida began reopening, so the hospital at which his dermatologist worked went to in-person appointments or in-state telehealth appointments only, leaving him without access to his health care provider.