Abstract
The management of psoriatic disease has been revolutionized by biologic medications in recent years. Despite their efficacy and safety, patients are often required by insurance plans in the USA or national formulary guidelines in other countries to try and fail other treatments first, which is a strategy called step therapy. Originally designed to contain costs of specialty drugs, step therapy has a number of negative impacts on patients and providers, both personally and clinically. This article is coauthored by a patient with psoriasis and psoriatic arthritis who navigated step therapy. She describes her early experiences with psoriasis and achieving disease control with biologic medication, only to later be diagnosed with psoriatic arthritis and need to revise this treatment plan. She then explains how insurance denials and step therapy impact her life physically, emotionally, socially, and medically. This case is then discussed from the perspective of a dermatologist specializing in inflammatory skin disease. We highlight the psychosocial burden of psoriatic disease, as well as the burden of step therapy and its impacts on patients, providers, and the entire medical system.