Nonetheless, over half of this cohort found AA to be moderately or seriously financially burdensome, and the average out-of-pocket costs of $1354 is similar to the average out-ofpocket costs of $1418 for patients with psoriasis. 4 The reallife willingness to pay of this cohort reflects the consequences of AA on the everyday lives of patients. Although future work is required to confirm these results and determine their generalizability to the overall community of patients with AA, these findings suggest that the negative psychological consequences of AA may be compounded by financial distress, which has been shown to place patients at risk for worse quality of life. 5 As payers begin to explore coverage around an increasingly promising pipeline for AA treatments, we hope that this evaluation can encourage broader financial coverage for treatments of this psychologically and financially burdensome disease-not just for pharmaceuticals, but for supplementary therapies as well. Physicians should be aware of the potential ramifications of treatment costs for patients and consider financial impairment as an unintended consequence of their recommendations.

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