You won’t believe the essential knowledge you need to know!

In the early 2000s, Caroline Williams began noticing small white flakes of skin on the shoulders of her clothing. “Dandruffhe thought, and tried to treat it with over-the-counter remedies. But he got worse and in 2004 he went to the doctor, who diagnosed him psoriasis.

Over the years, doctors have prescribed a myriad of creams, lotions, and shampoos for her to apply to her scalp. she even tried phototherapythat is when you expose your fur to special ultraviolet (UV) lights in the doctor’s office. But nothing seemed to help much, and his psoriasis kept getting worse.

Though so far confined to her scalp, her symptoms began to intrude on her life. It wasn’t just the embarrassment of the constant flakes, it was the itchiness. He could become so intense that it became almost impossible to think about anything else, let alone work or socialize.

“The constant desire to scratch can be overwhelming,” she says. But of course scratching only made it worse. Every doctor she’s been to, Williams says, has one thing for sure: “Don’t scratch.”

“Next one who tells me he’s going to get a quick kick to the shin,” he says.

In 2008, Williams switched to a dermatologist who prescribed her first biologic medication: Enbrel. It was a revelation.

“It was literally life changing for me after so many years of intense itching — not to mention consciously and constantly brushing scales off my shoulders and office chair.” Williams was elated. Why, he wondered, had he not been offered one of these biologics? medicines years before?

Biologics are specialized drugs that target specific parts of the body. immune system. when used for treat psoriasisthey block the actions of certain cells and proteins that are part of the disease development process.

You receive biologic therapy either through an IV or as an injection. With some of the medications, you may be able to give yourself the injections at home.

As for why these drugs weren’t widely offered at first, “It was different in the early years of biologics,” says Mary Spraker, MD, a clinical dermatologist and associate professor of medicine at Emory University.

Doctors and pharmaceutical companies still weren’t sure how safe and effective the drugs were, so they were wary of prescribing them too easily, he says.

In fact, the FDA only approved biologics for psoriasis in 2004. In 2008, it added a “black box” warning to some of the drugs about possible reactivation of tuberculosis and hepatitis B.

“These are serious drugs and we don’t yet know all the possible long-term effects,” says Spraker.

But over time, with more research and newer biologics that may be safer, doctors might start to feel more comfortable recommending these drugs for people with a milder form of the disease.

So even if your doctor hasn’t recommended them in the past, you can still ask if a biologic would be a good option, especially if you notice your symptoms getting worse.

Biological therapy is very expensive. A recent study found that a 3-year biologic treatment program can cost upwards of $180,000.

When Williams started this, his out-of-pocket expenses were relatively low, partly due to copay assistance from the pharmaceutical company. It probably didn’t hurt that she had excellent sure in the large company where he worked.

Due to the high cost of this therapy, insurance providers, including state health insuranceThey often have strict requirements. Even when you do, your copays can be in the thousands of dollars.

Pharmaceutical companies are aware of this. Many have programs to lower the cost of the copay. Some programs are for people who have next to no money (indigent), but others serve people like Williams, who simply can’t afford the huge copays some of these drugs require, even with good private insurance.

Williams was lucky enough to qualify for one of these programs, which made her copay very affordable. So if he’s taking biologics, it’s a good idea to check with the drug manufacturer for a program that can help with payment.

After a few years, as can happen with biologics, the effects of the drug began to wear off for Williams. Like a bad dream, the scales and incessant itching began to return.

“We really don’t know all the reasons why these drugs sometimes become less effective over time,” says Spraker, “but it’s important to talk to your doctor when it starts to happen, because there are a number of different things we can do to fix the problem. problem, including changing the type of biological medicine”.

That is exactly what happened to Williams in 2016. Her doctor switched her to another biologic: stellara. Again, relief came quickly, and with the help of co-pay assistance from the pharmaceutical company, the cost to her was nominal.

Then in 2018 something changed. Williams was getting close to Retirement old, and needed to return to her home country of England to care for her ailing mother.

He soon discovered that getting organic products in the UK was much more difficult. “He literally would have had to have been a fully walking leg flake to qualify for a biologic, which he wasn’t at the time.”

On Medicare, even with prescription drug coverageShe would be out of pocket $5,600 for the first two months of treatment only, with a copay of about $2,800 per injection.

Although it sounds like a lot, it is only a small fraction of the cost of drugs. Still, it was more than Williams could afford. She didn’t have that much Retirement savings, and she didn’t want to dip into them to pay for the medicines she’ll need for life.

But to requalify for co-pay assistance, he needed private insurance. And to get affordable private insurance, he needed to get a job. So that’s just what she did.

“It was 25 hours a week, which I didn’t want to do. I mean, I’m supposed to be retired. But that for me was a better alternative than having to spend my savings.”

This all took time, and it was in April that he received his first dose of Stelara. Her copay was $5.

Unfortunately, the new dose of Stelara hasn’t worked for Williams. She estimates that she still has psoriasis on about 75% of her body. Her doctor says that she will probably need to try a different biologic medication.

Now, Williams and her doctor have to navigate the hurdle again to make sure she qualifies to switch medications through her new insurance provider.

It feels, he says, like a never-ending journey.

Each insurance company has separate rules for changing drugs.

The problem goes beyond biologics and psoriasis, says Emory’s Spraker.

“Everyone is confused by health insurance.”

“Even through your employer, every year when you sign up for insurance, there is a different fine print. It’s really hard to understand what’s going to happen until you get the bill and then you have to make phone calls.”

Still, there are resources to help you get the treatment you need for your psoriasis. Organizations like the National Psoriasis Foundation can help guide you to the right place.

Your health care provider can also help. Emory Healthcare recently hired a pharmacist whose sole job is to help patients navigate the challenge of insurance approval for expensive drugs. It’s the same at the other two hospitals where Spraker works.

You can also ask your pharmacist or insurance provider or search for resources online. They usually can’t do everything for you, but they can usually provide helpful help and guidance.

“Most of the time,” says Spraker, “we can find a way.”