In 2018, when psoriasis lesions began to show on Seritta Frazee’s face, she decided it was time to take her disease seriously and to find the right treatment. Before then, she’d gotten away with covering her skin, but no one wants to live life in a ski mask.
With some other diseases or conditions, the road is a little easier. You go to the health care provider, you get your diagnosis, and you begin treatment that hopefully sends you on a path to wellness or sufficient disease management. As many with moderate to severe psoriasis or psoriatic arthritis know all too well, when the treatments you need are high-priced systemics – including today’s most effective biologics – the journey to appropriate treatment is rarely ever so linear.
To list out every step of the journey Frazee has taken over the last seven years would take several pages. She has had to navigate a series of hurdles and redirections that sadly, are quite common to folks living with psoriatic disease or other chronic conditions.
While waiting several weeks for an opening at her dermatologist, Frazee was left to manage her disease with topicals not meant to address the psoriasis on her face – a high-impact site that requires different treatment. When she did finally see a specialist, she was prescribed methotrexate. This drug was once the standard of care for severe psoriatic disease, but today we have many highly effective systemics with less impactful side effects. Methotrexate also requires regular bloodwork to monitor liver health, which isn’t the case with many other treatment options. Ultimately, Frazee went on the medication, but not without reservations.
“At the age of 23, I was faced with the medical decision to be prescribed methotrexate, an effective psoriasis medication with a laundry list of risks and side effects,” Frazee shared. “I was required to sign a formal consent, due to my age as a child-bearing female. I felt in that moment a feeling of, ‘Oh my goodness, what did I just do?’ because I knew that even though that decision would be beneficial for my psoriasis in that moment, the long-term effects would always be in the back of my mind.”
A First Look at Step Therapy
When Frazee moved from marketplace to employer-sponsored health insurance, she again had to work her way through a new provider and several treatment options. This time, she experienced step therapy, as her insurer insisted on a potent steroidal topical and light therapy despite the prescription for a biologic.