Biologics & Psoriasis: Medicare Patients

Psoriasis treatment in the geriatric demographic has long been poorly understood.

The elderly, who generally have greater comorbid burdens — increased risks of cardiovascular disease, diabetes, and renal disease – statistically comprise a growing population of the US.

Study results examining biologic treatment utilization and associated factors in a nationally representative sample of Medicare patients with psoriasis, were presented at the American Academy of Dermatology Annual Meeting in San Francisco, CA.

Junko Takeshita, MD, PhD, University of Pennsylvania, PA and colleagues conducted a retrospective cross-sectional study using the 5% random sample Medicare claim files to examine beneficiaries with continuous fee-for-service Medicare Part A and B coverage and stand-alone Part D plan enrollment in 2010.

The study included a total of 4,107 patients who had at least 2 claims for psoriasis (ICD-9 code 696.1). The team considered the receipt of phototherapy, oral systemic, or biologic therapy as a benchmark to define moderate-to-severe psoriasis.

Biologics were used by 433 patients (11% of all psoriasis patients; 38% of patients with moderate-to-severe psoriasis) and were distributed as follows: adalimumab 35%, alefacept 1%, etanercept 47%, infliximab 21%, and ustekinumab 6%.

Among biologic users, 28% used a physician-administered biologic covered under Part B medical benefit and 82% used a self-administered biologic covered under the Part D drug benefit. Similar patterns of biologic use were found when psoriasis was identified based on at least one dermatologist claim of 696.1.

Analyses cited age and malignancy as linked to lower odds of biologic use. Patients lacking low-income subsidies (LIS) had 70% lower odds of biologic use, compared with patients having minimal out-of-pocket LIS. Additionally, patients with concomitant psoriatic arthritis experienced 4-fold higher probability of using biologics.

Authors concluded, “Only a third of Medicare patients with moderate-to-severe psoriasis used a biologic in 2010. Results suggest that younger age, having LIS under Part D and presence of psoriatic arthritis were positively associated with biologic use. Higher out-of-pocet costs among patients without LIS may limit access to biologics among Medicare Part D patients with moderate-to severe psoriasis.”