Advance Online
Pictures of Tammy Stafford and her family
Advance Online

Full Circle

Tammy Stafford did not know that she would be helping her future self.

Most people remember their 21st birthday as an exciting time, but Tammy Stafford simply remembers her unfortunate birthday present. “That's when the first patch of psoriasis showed up on me,” Tammy said. “It was high on my forehead, right at my hairline.” Growing up seeing her mom struggle with psoriasis, Tammy was familiar with the disease and knew that it was a lifelong “gift.”

Tammy lives with her husband in Little Rock, Arkansas. They are now empty nesters, with their youngest off to college. None of her three children have psoriasis, and she hopes that it stays that way. The only other person she knows in Little Rock with psoriasis is a fellow mom, Nashwa Krisht, but when they first discovered their connection, they didn’t discuss it much. “It was still kind of kind of a hush hush thing,” she said. “She is [now] one of my very best friends. We definitely lean on each other.” Tammy said Nashwa is one of her biggest supporters.

Over the years, Tammy has had practically every part of her body covered in psoriasis at some point, other than the palms of her hands and the soles of her feet. Despite this, she has always been conservative with her treatment choices. She was worried about putting something foreign in her body. Tammy now has nearly 50% of her body covered in lesions. She has had decades of mediocre results from using various topicals and phototherapy, but knowing that psoriatic disease is systemic – involving inflammation throughout the body and increasing the risk for a number of other diseases – Tammy decided to fight a systemic disease with a systemic treatment. It was time try out a biologic.

After talking with her dermatologist and getting the prescription, she was excited by the possibility of being clear of skin symptoms for the first time in years. She found out soon after that her insurance had denied coverage of the prescribed biologic. “In here they stated that it is ‘not medically necessary,’” Tammy told me. She said that the insurance document suggested less expensive treatments as alternatives.

This practice is known as step therapy, or fail-first, and can often cause people to wait months or even years to receive the treatment that was originally prescribed to them. “I had a lot of emotion reading that,” Tammy said. “I was so mad because I thought whoever sat down and did all this obviously doesn’t have psoriasis.”

But let’s back up.

Years before Tammy decided to go on a biologic, her dermatologist introduced her to the National Psoriasis Foundation (NPF). She consumed as much as she could find about psoriatic disease on the NPF website, including reading Advance articles and listening to the Psound BytesTM podcast. Becoming an NPF member was an easy decision. “That was a huge turning point, and that's when I really got involved and we talked about doing something in Arkansas,” said Tammy.

She recruited her friend Nashwa and with the help of NPF, organized the 2020 Pstamp Out Little Rock – an event that typically features a raffle, games of bingo, and plenty of lively fun. As with many events in 2020, it was nearly thwarted by the pandemic, but Tammy and the team adapted and held the event virtually a few months later than originally planned. It was so successful, they quickly started planning for the 2021 event.

As impressive as that is, Tammy was also involved with NPF as a patient advocate for Senate Bill 99, which quickly passed the Arkansas Legislature and was signed into law as Act 97 in February 2021. This new law, which took effect January 1, 2022, improves access to care by updating step therapy protections and providing a clear and timely process for health care providers to submit an exception request.

Having learned about step therapy through her advocacy with NPF, Tammy knew exactly what was happening when she received her insurance denial for the biologic. “And as crazy as this sounds, I was actually excited when I was saw it, even though I was disappointed. I was excited because I thought, ‘I know about this!’ You know, I just got to see how this works,” Tammy said.

“What I found amazing [about the new bill] was how it works and why it's so important,” she shared. Tammy received the denial at the end of 2021 and knowing that the bill would be taking effect in a few short weeks, “I said ‘we just need to get to January 1 of 2022 and it'll be OK.’ And sure enough, I got a call last week,” Tammy said. Now that she is approved for the biologic, she is eagerly waiting the final paperwork to go through.

Because of her work on the step therapy bill and the resources NPF provides for handling insurance denials, she was not worried about managing the process. “But I think about, gosh, how many people have to go through this, and they don't have the resources,” she said. “Probably, a lot give up. I mean, it's quite the process.”

NPF continues to advocate for all those living with psoriatic disease in the United States and provides up-to-date resources for all areas of life with psoriasis. “I can't imagine living with psoriasis and not having NPF in my life. It's been a blessing,” Tammy told me. She plans to continue her involvement with NPF in any way she can – grateful to make a difference for others like her. She also promises to keep us updated on her progress once she starts the biologic.

Handling Surprise Medical Bills

Step therapy isn’t the only challenge facing people like Tammy and John.

Read John’s story

Stay in the Know.

Expert tips, can’t-miss events and the latest news, straight to your inbox.

National Health Council Standards of ExcellenceCharity Navigator

Copyright © 1996-2022 National Psoriasis Foundation/USA


Duplication, rebroadcast, republication or other use of content appearing on this website is prohibited without written permission of the National Psoriasis Foundation (NPF).


NPF does not endorse or accept any responsibility for the content of external websites.


NPF does not endorse any specific treatments or medications for psoriasis and psoriatic arthritis.

We use cookies to offer you a better experience and analyze our site traffic. By continuing to use this website, you consent to the use of cookies in accordance with our Privacy Policy.