Prevalence of Utilization Management Policies Among the Psoriatic Disease Community: Results From the 2019 National Psoriasis Foundation Advocacy Survey

Abstract

Introduction: Utilization management (UM) policies are becoming more common among commercial insurance policies. However, little research has been conducted to understand the prevalence of experiencing UM restrictions among patients with psoriatic disease. Objectives: To understand the prevalence of UM policies within the psoriatic patient community and examine their relationship with patient characteristics. Methods: An online survey of 1205 individuals with a psoriatic disease from the National Psoriasis Foundation’s constituent database was conducted. Data were collected from July 7 to July 31, 2019. The main outcomes of interest for the present study were frequency of experiencing UM policies (eg, prior authorization [PA] or step therapy [ST]) from their insurance company, number, and type of UM policies experienced and relationship between patient characteristics and experiencing these policies. Results: Survey respondents reported high rates of experiencing some form of UM restriction (80.5%). Nearly half (45.1%) of the survey respondents indicated their insurer required them to try a therapy other than the therapy originally prescribed by their physician, a practice known as ST or “fail first” and 73% of respondents reported having to receive PA from their insurer before initiating treatment. Conclusions: Individuals with psoriatic disease commonly encounter UM policies from their insurer when attempting to manage their disease. Statistical analyses suggest that UM policies are related to the type of treatment used by patients and the type of psoriatic disease.

Psoriasis Prevalence in Adults in the United States

“…The National Psoriasis Foundation is a US-based, nonprofit patient advocacy organization committed to improving the lives of those living with psoriasis and psoriatic arthritis through advocacy, education, and research. The National Psoriasis Foundation has several ongoing initiatives that help further characterize the epidemiology of psoriasis . In addition, the Global Psoriasis Atlas is an international collaborative effort to provide information about the worldwide epidemiology of psoriasis .…”

The National Psoriasis Foundation Recognizes the Critical Role of Nurses in Caring for the Psoriatic Disease Community

“…Of the 1,570 participants to the 2019 NPF Annual Survey, nearly 4% see a nurse practitioner (2.4%) or general physician assistant (1.3%) as their primary healthcare provider treating their disease (Figure 2; Gondo & Bell, 2019).…”

“…Among those remaining uninsured, nurses play an important role. According to the same 2019 NPF Annual Survey, more than 50% of uninsured patients are receiving their care from someone other than a specialist (Gondo & Bell, 2019). These patients, along with patients in Medicare, report the highest rates (24.1% and 25.1%, respectively) of monthly out-of-pocket costs in excess of $200.…”

“…Regrettably, despite the many treatment options for individuals with all levels of psoriatic disease severity, many individuals living with psoriatic disease experience considerable barriers to care. For example, looking across patients of all insurance types, more than 30% of individuals indicated that they experienced strain because of the cost of their biologic (Gondo & Bell, 2019). The NPF's advocacy and government relations team, working in partnership with other healthcare stakeholders, is actively working to address these barriers through policy change.…”