INTRODUCTION
Selecting a systemic therapy for a patient with psoriasis is a complex process, based on a variety of factors including psoriasis severity, comorbid health conditions, access to care, and both patient and provider preference. Recognition of prescription patterns associated with biologic medications for psoriasis is important to understand healthcare utilization. Much of the previous research regarding the utilization of biologics in the United States comes from analysis of prospective patient registries and adjudicated insurance claims datasets.1-5 An insurance claim is only generated when a prescription is submitted by the patient to the pharmacy, approved by the insurer, and, if necessary, paid for by the patient. There is ample evidence, however, that biologic prescriptions are often subject to more restrictive coverage policies and/or high out-of-pocket costs leading to the prescription’s rejection by the insurer or abandonment by the patient.6,7 Utilizing electronic health records (EHR) data to examine prescriptions written is a different way to understand drug utilization that captures more of the treatment selection process and is important to understand the full selection process that occurs from the time the first prescription is written until a patient actually starts a medication. Biologic therapies are highly efficacious treatments for psoriasis, but most treatment guidelines, recommend concomitant use of adjunct therapies as necessary in those with continued disease activity.8-10 Little has been reported about the actual utilization of concomitant psoriasis therapies including topical medications, phototherapy, and other systemic agents in patients on biologics. Analysis of concomitant prescriptions using claims data would only capture medications picked up from the pharmacy, but electronic health records captures all prescriptions written, signifying any time a provider thought adjuvant therapies were necessary, regardless of whether a patient decided to start the medication. The objective of this study was to utilize data from EHR to understand prescribing patterns associated with biologic therapies for psoriasis and investigate utilization of concomitant psoriasis therapies, including topical medications, phototherapy, and other systemic agents in patients on biologics in the United States. Evaluation of psoriasis medications through EHR will provide a different perspective on drug utilization, increasing the overall understanding of healthcare utilization in psoriasis.
