5 Ways to Reduce the Cost of Biologic Treatment for Psoriasis
When you have an inflammatory condition, such as psoriasis or psoriatic arthritis, biologic medications can work wonders to calm inflammation, reduce symptoms, and prevent further joint damage.
Biologics have revolutionized treatment, says Stuart Kaplan, M.D., chief of rheumatology at Mount Sinai South Nassau Hospital in Oceanside, New York, and partner at Rheumatology Consultants, LLC. Instead of targeting the entire immune system, like traditional systemic medications do, biologics target specific immune pathways, making them effective and less likely to cause side effects.
But this type of disease-modifying anti-rheumatic drug (DMARD) often comes with a hefty pre-insurance price tag. Here, experts share why biologics are so expensive and strategies to help you afford this treatment, if it’s right for you.
When Do Doctors Recommend Biologics?
Biologic medications act like an arrow, precisely targeting specific proteins and cells that lead to inflammation, says board-certified rheumatologist Diana Girnita, M.D., Ph.D., founder of Rheumatologist OnCall, in Palo Alto, California.
For mild or occasional psoriatic flare-ups, biologics aren’t necessary. In those cases, doctors may recommend or prescribe topical creams for people with psoriasis. People with mild psoriatic arthritis might be recommended non-pharmacological interventions, such as exercise and physical therapy, followed by familiar over-the-counter, anti-inflammatory medications such as ibuprofen. If symptoms don’t ease, then doctors may prescribe non-biologic systemic medications (usually, oral pills) or biologic medications.
“When the joints are still inflamed and the blood is showing markers of inflammation, then we go to the next line, which is usually biologic drugs,” Kaplan says.
And for people with psoriasis, biologics may become the preferred treatment method when your case is moderate to severe, treatments fail or cause unpleasant side effects, other treatments are contraindicated, or your quality of life is severely affected (for example, you can’t type at work because your fingers hurt or you can’t be in a relationship because you are so self-conscious about your body).
How Much Do Biologics Cost?
The price of biologics is gasp-inducing: On average, a year’s treatment costs anywhere from $22,000 to $44,000, according to the The Rheumatologist. And, keep in mind biologics are a long-term strategy (think: years of treatment, or more), says Girnita.
There are a few reasons biologics are so expensive:
- They require a ton of research and development. As is true for all medications, a huge amount of time is required to develop biologics. “It involves a lot of human input and trial and error,” Kaplan says.
- The manufacturing process is complex. Biologics are monoclonal antibodies. That means “they’re actual proteins or antibodies that are produced by live cell lines,” Kaplan explains. Manufacturing medications using live cell lines ups the cost compared to chemical-based drugs.
- They’re not a pill. These meds are taken either via subcutaneous injections (into the skin) or IVs (intravenous or into a vein), which can affect the price.
- They’re not easily imitated. For drugs that are created by synthesizing chemicals, the process is easily replicated once you have the formula nailed down. Not so for biologics. “Once you get a particular monoclonal antibody, no one else can really produce that exact same cell line,” Kaplan says.
5 Tips to Pay Less for Biologics
If you have health insurance, most—or even all—of the price of biologics may be covered.
That said, the process is far more complicated than filling a prescription for eye drops or other everyday meds: Your doctor will have to fill out a pre-authorization form justifying the prescription. Sometimes, insurers will deny this initial request, or say they prefer a different biologic to the one your doctor earmarked.
And, some insurance plans don’t cover biologics at all, or have a monthly co-pay or a deductible that’s too high for you to afford, Kaplan says. “That’s a problem.”
But, you’re not without options if you’re finding it tough to afford biologic treatment. Try these strategies to help pay for them:
1. Explore Patient Assistance Programs
Check to see if there’s assistance available through your medications’ manufacturer. Most companies that make biologics have patient assistance programs, says Paul Pruitt, CEO of SHARx, LLC, a patient-advocacy service. There are a few different types:
Co-Pay Coupons and Savings Cards
If you have health insurance, check if the drug company offers a savings card to cover the cost of your insurance copayment. Co-pay coupons and savings cards can help with out-of-pocket costs, like daunting copays or high deductibles, Pruitt says. In some cases, if the manufacturer of your prescribed biologic has a support program, your co-pays could be covered completely, depending on your health insurance.
Programs like this are typically only an option if your insurance covers the drug. Pruitt notes. They’re offered by most, if not all, drug manufacturers.
Manufacturer Support Programs
Sometimes, pharmaceutical companies “give the patients the medication for free if their insurance refuses it,” Kaplan says. Through some manufacturers, for example, medication can be covered for up to two years if a person's insurance company doesn’t initially agree to cover the prescription costs.
Some drug companies maintain foundations to cover the costs of medications for people without health insurance or with limited insurance whose income is below a certain threshold.
2. Reach Out to Nonprofits
Organizations such as the Arthritis Foundation or National Psoriasis Foundation offer helpful information about getting medication covered and sorting out health insurance options on their websites—you can also call their helplines for one-on-one insights.
The following nonprofits provide easily searchable information on assistance programs and other resources:
3. Check State-Level Programs
It’s possible that your state can provide financial support, Girnita says. Typically, state-level programs are designed to help people with Medicare or people over age 65 get coverage for prescription medications. Browse a list of state-level pharmaceutical assistance programs.
4. See What Form Your Insurance Covers
If a biologic is available in two different forms—IV and injection—it’s possible that one option may be cheaper than the other. That will depend on your situation: For example, Medicare Part D (drug coverage) typically doesn’t cover injectable medications, Kaplan says—but if you get the medication intravenously, it’s considered an in-office medical procedure, and covered under Medicare Part B.
For those who don’t have Medicare, subcutaneous injections, which you can do yourself at home, are typically cheaper. “If you go to the hospital and they do an IV, it's going to be much more expensive,” Girnita points out.
5. Ask Questions and Start Conversations
Don’t be shy about asking your doctor or pharmacist what’s available. If you’re receiving biologics at a hospital, it may offer financial support, and your pharmacy may have a way to discount the price, Girnita says.
“The most important thing for people to know is they should reach out to their rheumatologist or dermatologist and ask for support,” Girnita says. “We are partners with our patients.”
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