Psoriasis Treatments by Payment Type in the US Outpatient Office Setting

October 2013 | Volume 12 | Issue 10 | Original Article | 1095 | Copyright © October 2013

Kenyatta Mireku BS,a Karen E. Huang MS,a Swetha Narahari MD,a Scott A. Davis MA,a and Steven R. Feldman MD PhDa,b,c

aCenter for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC
bDepartment of Pathology, Wake Forest School of Medicine, Winston-Salem, NC
cPublic Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC

BACKGROUND: Many factors, including patients' methods of payment, may influence psoriasis treatment decisions.
OBJECTIVE: To characterize psoriasis treatments by patients' types of payment in the US outpatient office setting.
METHODS: Using the National Ambulatory Medical Care Survey (NAMCS), a large survey that samples outpatient office visits to US non-federally funded physicians, visits linked with sole diagnoses for psoriasis (ICD-9-CM: 696.1) were identified. There were 545 unweighted records. The types and number of treatments prescribed at these visits were categorized by expected major payment type to be used for the visit.
RESULTS: Mainstay psoriasis therapies such as vitamin D analogs and clobetasol were prescribed regardless of payment type. Retinoids were also within the most frequently prescribed psoriasis medications for all payment types, however they were less frequently prescribed than vitamin D analogs. Payment type did not have a significant effect on the number of medications prescribed at psoriasis visits.
LIMITATIONS: Data on treatment adherence and filling of prescriptions are not included in the NAMCS database.
CONCLUSION: Prescribing patterns for psoriasis medications are similar across payment type. Additional factors appear to modulate therapy choice for patients with psoriasis.

J Drugs Dermatol. 2013;12(10):1095-1097.


Psoriasis is a chronic, immune-mediated, systemic inflammatory disease afflicting 0.6 to 4.8% of the population.1;2 There is no cure for the disease, necessitating lifelong treatment for management of the clinical symptoms. Patients suffering from psoriasis not only experience significant impact to their health-related quality of life but also face a financial and psychosocial burden.3 Healthcare costs related to psoriasis are increasing as newer and more expensive medications are developed.The estimated annual cost is approximately $11.3 billion.4-6
Treatment options for psoriasis have evolved over time as newer and more effective medications are being discovered.7 Physicians have an endless variety of options and combinations to choose from when picking the most effective therapy to treat their patients. 8 Factors influencing a physician’s decision in choosing the best therapy for a patient include disease severity, therapeutic efficacy, treatment impact on quality of life, patient preference, cost effectiveness, and the patients’ health insurance.8;9 Treatments vary in their costs, both the out-of-pocket costs to patients and the total societal cost of the medication. For mild psoriasis, treatments can range from corticosteroids that costs tens of dollars per tube of product to vitamin D analogs, retinoids, tacrolimus, and pimecrolimus which cost hundreds of dollars per tube of product. Similarly, for moderate to severe psoriasis, there are more affordable treatments, such as methotrexate and cyclosporine, and biologic treatments costing tens of thousands of dollars.10;11
As health insurance status may affect access to treatment, we sought to assess the degree of influence payment type has on physician prescribing patterns in the US ambulatory office setting.


This study is a secondary analysis of data collected in the National Ambulatory Medical Care Survey (NAMCS) for psoriasis visits. The NAMCS is an annual, national sample of ambulatory visits made to physicians in the US who are non-federally employed. It is conducted by the Centers for Disease Control and Prevention, National Center for Health Statistics. Data are collected using a three-staged sample design consisting of sampling geographic areas, then physicians, and finally visits to that physician’s office for a random week. For sampled visits, medical records are used to abstract the data, either by the physician, the physician’s staff, or Census Bureau field staff. Information regarding patient demographics, diagnoses made by the physician (up to three), medications prescribed, and physician specialty, along with other visit characteristics are collected during data abstraction. Diagnoses were classified with the International Classification of Disease, 9th Revision, Clinical Modifications (ICD-9-CM).
In this study, sampled visits between 1997 and 2010 with a sole diagnosis of psoriasis (ICD-9-CM: 696.1) were included. There were 545 records meeting these criteria. We analyzed medi-