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For more than 7.5 million adults in the United States, living with psoriasis means navigating not only physical and emotional challenges, but also a financial burden. This chronic autoimmune condition causes rapid skin cell production, leading to scaling, inflammation, and redness of the skin. With no cure, managing psoriasis often involves frequent doctor visits and costly therapies, which can quickly add up in both stress and dollars.
Psoriasis Treatment Options: What is Light Therapy?
Psoriasis can appear in different forms and affect various parts of the body. A range of treatments are available that can help manage symptoms and reduce the risk of developing psoriasis comorbidities such as psoriatic arthritis, heart disease, obesity, diabetes, and depression.1 Treatment options include topical and oral drugs, biologics and targeting drugs, and ultraviolet B (UVB) light therapy.
Light therapy, also known as phototherapy, involves exposing the skin to controlled amounts of ultraviolet light on a regular basis. UVB light is the most commonly used type of light therapy that penetrates the skin and helps slow the growth of affected skin cells. Light therapy can be administered in a health care provider’s office, a clinic, or at home with a prescribed light therapy unit. In a meta-analysis, 70% of patients achieved meaningful improvement after 20-40 sessions of UVB light therapy.2 In another analysis, combining UVB light therapy with methotrexate, an oral drug, resulted in 94% of patients achieving meaningful improvement in psoriasis severity.3
Understanding the Cost and Efficacy of Psoriasis Treatment Options
With several treatment options available for managing psoriasis, costs and efficacy can vary.
Estimated Efficacy | Estimated Costs | |
|---|---|---|
Conventional Oral Drugs | 20-60% | $325 – $3,400 per year |
Office-Based Light Therapy | 70%
and up to 94% in combination with conventional oral drug | $6,000+ per year |
Home-Based Light Therapy | $950 – $6,200 one-time | |
Biologic Drugs | 33-90% | $52,000 for the first year |
In 2023, National CooperativeRx implemented CVS Caremark’s enhanced psoriasis criteria to better manage psoriasis therapies for our members. This criteria was designed to ensure cost-effective, guideline-based therapies are used before more expensive psoriasis biologics. Combined with our in-house specialty prior authorization program, this resulted in an estimated $27.4 million in psoriasis savings for our member groups in 2024.
Despite these significant savings, psoriasis remains a costly condition due to the price of psoriasis biologics. These biologics can be an attractive option for patients, as copay coupons are available and offer the biologics at little to no out-of-pocket cost. However, plan sponsors remain responsible for covering the drug’s high cost.
To help address this challenge, the National CooperativeRx Clinical Team identified an opportunity to offer our members and their patients a more cost-effective option to psoriasis management, without compromising quality of care.
Introduction to National CooperativeRx’s Home-Based Light Therapy Program
Starting August 1, through a partnership with a phototherapy vendor, National CooperativeRx will be offering a home light therapy unit for no out-of-pocket cost to patients with moderate-to-severe psoriasis. Member groups are responsible for the cost of the phototherapy units but will benefit from preferred pricing through our vendor partnership. We estimate first-year cost avoidance to be between $2.4 million and $14.7 million across our membership.
The program will be integrated within the National CooperativeRx-led specialty prior authorization program and coordinated by our clinical team. Member groups will need to opt into the light therapy program for their patients to be considered for eligibility. Patients must meet clinical requirements/plan-approved criteria. Please note, the program is intended to provide home light therapy to patients who are newly starting biologics. Patients currently on biologics will require plan and patient consent to switch from their current biologic to a home light therapy unit.
Once the approval and ordering process is complete, a unit will be shipped to the patient’s home. Instructions and guided videos will be provided to both patients and providers. Unit maintenance will be provided by the vendor and treatment protocol will be determined by the patient’s provider.
As with all National CooperativeRx clinical programs, there is no fee for this program. Member groups are responsible for only the cost of the unit. There is no mark-up on the cost of the units. National CooperativeRx Account Representatives can provide detailed information on cost dynamics and educational materials upon request.
Value to Patients and Plan Sponsors
National CooperativeRx’s Home Based Light Therapy Program:
For Patients:
- Increases access to safe and highly effective psoriasis treatment
- Reduces geographic barriers
- Reduces cost barriers
- Reduces time and scheduling conflicts of office-based light therapy
For Plan Sponsors:
- Can help reduce new-start biologic spend
- Can help reduce topical and oral drug spend
- Decreases medical spend for office-based light therapy/office visits
- Increases quality of life for plan participants
- Increases productivity of plan participants
- Increases plan satisfaction
Conclusion and Next Steps
At National CooperativeRx, we are committed to delivering the highest-quality, most cost-effective prescription benefits. Our Home-Based Light Therapy Program offers member groups and their patients a safe, convenient, and affordable psoriasis management option.
Primary contacts for member groups will receive an email with more information about the opt-in process. Primary contacts will need to inform National CooperativeRx about their desire to participate in the program and understand the cost dynamics of the devices. If we do not receive a response, we will assume they do NOT want to participate in this program. If they choose not to opt into the program at this time, they may add it in the future with a 30-day lead time requirement for implementation.
Thank you for your continued membership and partnership as we work together to enhance the quality and affordability of prescription benefits.
Sources
- National Psoriasis Foundation. (n.d.). About psoriasis. https://www.psoriasis.org/about-psoriasis/
- Archier, E., Devaux, S., Castela, E., Gallini, A., Aubin, F., Le Maître, M., Aractingi, S., Bachelez, H., Cribier, B., Joly, P., Jullien, D., Misery, L., Paul, C., Ortonne, J. P., & Richard, M. A. (2012). Efficacy of psoralen UV-A therapy vs. narrowband UV-B therapy in chronic plaque psoriasis: A systematic literature review. Journal of the European Academy of Dermatology and Venereology, 26(Suppl. 3), 11–21. https://doi.org/10.1111/j.1468-3083.2012.04519.x
- Schuster A. Psoriasis and related diseases. Praxis. 2016. https://www.praxis-schuster.ch/wp-content/uploads/2016/10/Almutawa.pdf
