Psoriasis Woes: Frustrations of Insurance & Step Therapy

There are many things I find absolutely maddening about living with psoriasis. You would think that having lived with this condition for over 17 years I would be used to things by now. However, I can tell you that I am not.

First, of course, there is the itch. That within itself is enough to make anyone mad. Second, are the countless doctors’ visits. Third and the most maddening of all of it are dealing with the insurance companies whenever the treatment has to be changed.

I do not know about you but I feel that the insurance companies have too much say in our treatment regimen. I'm talking about step therapy. Why must they dictate what I have to try first before I can move on to the actual treatment that my doctor and I agree upon?

A medication switch

Right before the pandemic hit, I started having a lot of problems with my stomach. I go see my primary care doctor who in turn diagnoses me with what he thinks is ulcerative colitis. Having had psoriasis for so long I know that other medical conditions are a real possibility.

Because of the pandemic, it takes months to finally get the test done. Turns out I did not have ulcerative colitis. I was on Cosentyx at the time this started. It was working great for me. However, because it took so long to get the test done and because the biologic is known to make that specific condition worse, I had to be switched to something else.

What should have been an easy choice

I am very involved in my treatment. My rheumatologist and I finally picked something new to try. To my surprise, there was no problem with the insurance company. They immediately approved it without any appeal or anything. I could breathe a sigh of relief on that one. Like most of us, I go into any new treatment hoping it is going to be the one that really works for me.

Sadly this was not to be the case. Eight months into the treatment, we saw no improvement. Here my rheumatologist and I went again needing to discuss my history of treatments to figure out where we go next. I was excited about the outcome. We decided that since Cosentyx was working well for me that we should try to go back to it. I thought this was an easy choice, right? Wrong!

Fail First or Step Therapy Reform

I am quite proud to live in Lousiana - partially because just last year, the local government signed into law a Fail First or Step Therapy Reform. There is one shortfall to that law though. While it protects people who have private insurance it does not protect those who have Medicaid. Therein lies my problem.

I thought that being on Medicaid would be a blessing. In some ways, it has been. Not having the protection of the Step Therapy Reform law I have to deal with the insurance company once again stepping in to demand I try and fail a different biologic. When is this going to stop? Why should the insurance company have more of a say in my treatment than I have? Than my doctor has?

Step therapy needs to be a thing of the past

The National Psoriasis Foundation keeps fighting against Step Therapy or Fail First. It just seems that there is so much more work to be done in this area. Step therapy needs to be a thing of the past. We shouldn’t have to live with a disease like psoriasis and have to deal with the insurance company’s rules when it comes to our treatment.

It makes me mad that again I am in this situation. Just for reference, I am interested in learning if any of our readers have state insurance like Medicaid and have to deal with step therapy. Please share. Maybe this can be the beginning of the end of step therapy.