Care Path: Making a Treatment Decision

The following are some questions that you may want to ask when deciding which treatment may be best for your psoriatic disease.

• What is the advantage of taking this treatment instead of others?
• How is this treatment given? How often is this treatment given? Can I take this treatment at home or do I have to come into the office?
• How long will it be before a treatment starts to work? How much improvement can I hope to see? At what point should I try something different?
• What are the possible side effects and long-term risks, and how likely is it that I will develop them? Is there anything I can do to reduce the risks or manage the side effects?
• Will I need to do tests or bloodwork while taking this treatment? If so, what kind of tests and how often?
• Who do I contact if I experience side effects while taking this treatment?
• What is my next option if I do not want to do this treatment or this treatment does not work for me?

Here are sources that can help you learn about your options:

• Your health care provider can talk about what treatments are available to you. Your provider can also recommend a treatment that works with your health history and other treatments that you are taking. This is personalized advice that only a health care provider can give.
• The National Psoriasis Foundation offers information about treatment options online and from the Patient Navigation Center (PNC). A Patient Navigator from the PNC can explain what types of treatments are available in the United States.
• Trusted online sources are one of your best sources of information. Visit credible websites that are based on science such as the NPF website, MedlinePlus.gov, or the website for your specific treatment. Remember that what works for one person’s body may not work for yours. In some cases, what works for others could be harmful to your body.

Living with psoriatic disease often requires frequent medical appointments and prescription treatments. It may be hard to keep up with the cost of your appointments and treatments when you are uninsured (do not have health insurance). Even people with health insurance may find it hard to access the care they need when their coverage still leaves them paying high costs. This is often referred to as being “underinsured.”

Whether you are uninsured or underinsured for a short- or long-term, here are some options that may help you access health care and treatments affordably.

• Sign up for Bridge programs and Patient Assistance Programs: You can learn about bridge programs and PAPs by visiting the drug manufacturer’s website or talking with your health care provider. You can also contact the Patient Navigation Center for assistance finding a PAP or bridge program.
• Pay “out-of-pocket” to see a health care provider: Some health care providers will see patients who are uninsured. Instead of billing your health insurance, the provider will bill you for the price of the visit.
• Ask for samples: Some health care providers have samples of prescription treatments or over-the-counter (OTC) products.
• Search for the lowest treatment cost: There are apps and websites that can help you find pharmacies in your area that carry your prescribed treatment at the lowest cost, such as GoodRx, Pharmacy Checker, and RxSaver.
• Go to a free or low-cost clinic: Federally Qualified Health Centers (FQHCs), also called Health Centers, offer primary care for free or on a sliding scale (you pay what you can afford) for people who are uninsured or underinsured.
• Work with your primary care provider to treat psoriatic disease: There may be times when seeing a specialist is difficult. In these limited situations, your primary care provider may be able to effectively manage your psoriatic disease.
• Participate in a clinical trial: Clinical trials are research studies using human volunteers that are designed to find better ways to prevent, screen for, diagnose, and treat disease. You can sign up to receive clinical trials in your area or visit ClinicalTrials.gov.

At this time, there is no cure for psoriatic disease, although the NPF is funding research to better understand the disease and develop a cure. Although some individuals may go into remission (no signs or symptoms of disease activity) it is very likely that the symptoms will return at some point (also known as a flare).

For many people, reducing skin and joint symptoms are the main goals of treating your psoriatic disease. You may have other treatment goals and other ways to see how a treatment is working for you.

• Are you able to sleep better because itch or pain has decreased?
• Are you able to do activities that you enjoy?
• Are you feeling happier and more confident?
• Are you able to move more easily?

The National Psoriasis Foundation (NPF) and the American Academy of Dermatology (AAD) issued a set of treatment targets for people with psoriasis and their health care providers. These targets do not recommend a specific kind of treatment, since treatments may work differently for different people. The targets set a goal of how much improvement you should expect to see after a certain amount of time.

*It may be acceptable to have less than 3% of your BSA affected by psoriasis (or have experienced 75% improvement) at this time.

The Treat to Target goal is to get your psoriasis down to 1% of body surface area (BSA) or less in 3 to 6 months after starting a new treatment. You can measure your BSA and track your progress on your own. Your entire hand (the palm, closed fingers, and thumb) is equal to about 1% of your BSA.

• If your psoriasis is reduced to 1% or less of your BSA, you have met the goal. Your health care provider can recommend how to continue to keep your psoriasis at this level.
• Suppose after 3 months, you have experienced an acceptable response (psoriasis covering 3% or less of your BSA or you have experienced 75% improvement). In that case, it is important to talk with your health care provider. You and your health care provider may decide to continue with your treatment plan for another 3 months or to try different treatment options.

Because psoriatic arthritis can cause permanent joint damage if not treated, your health care provider may recommend following a treat to target approach. This approach could delay or prevent further joint damage and could decrease pain and improve quality of life.

Once you have reached that 1% goal, you should check in with your health care provider every 6 months to make sure you are maintaining the level of clearance.

Learn more about sticking to your treatment plan and caring for your overall health so you can keep thriving.