Ensuring Patients with Severe Psoriasis Get the Medication They Need
Summary
- A University of Miami Miller School of Medicine/Jackson Memorial Hospital collaboration provides biologics for psoriasis in Miami-Dade County patients.
- Psoriasis is more than a skin condition. It’s associated with hypertension, diabetes, obesity and cardiovascular conditions, and can exact a serious psychological toll.
- 94.4% of patients on biologics incurred no out-of-pocket costs, underscoring the effectiveness of both public insurance and manufacturer-sponsored coverage pathways in minimizing financial barriers to treatment.
Psoriasis isn’t just a minor inconvenience that makes your skin itch. It’s a disease that affects more than 8 million people in the United States, 60% of whom say it’s “a large problem” in their everyday lives, according to the National Psoriasis Foundation.
“I used to think this is just like a skin-related disease,” said Sammya Mufarrej, whose UM skin biology and dermatological sciences Master’s thesis used data from the Jackson Memorial Hospital/University of Miami Miller School of Medicine monthly psoriasis biologics clinic, where she now coordinates clinic operations. “But then I realized that it’s much bigger than that. It’s associated with hypertension, diabetes, obesity, severe cardiovascular conditions…it’s a big deal.”
And the toll psoriasis exerts is more than just physical.
“We’ve seen patients who didn’t want to go out, didn’t want to wear shorts or short sleeves,” said Paolo Romanelli, M.D., the clinic’s attending physician and a professor in the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the Miller School. “Some were depressed, even suicidal. But thanks to biologics, they have a new life.”
Bridging the Biologics Affordability Gap
For patients with severe psoriasis, biologic therapies offer efficacy, convenience and improved quality of life. However, these treatments are considerably more expensive than traditional therapies such as methotrexate and cyclosporine. Insurance coverage for biologics remains inconsistent and out-of-pocket costs can be prohibitive for uninsured or underinsured people, who are more likely to suffer from severe psoriasis and less likely to afford the most effective treatments.
The Jackson Memorial Hospital/Miller School clinic is working with private insurance companies, government agencies and pharmaceutical companies to ensure their patients receive the biologic therapies their conditions require and would otherwise not be able to afford.
The clinic, which recently celebrated its 20th year anniversary, has three core aims:
• Facilitate access: Enable more patients to receive biologic therapies.
• Centralize expertise: Bring together physicians and staff skilled in securing biologics through pharmaceutical assistance programs and county resources.
• Train future leaders: Provide dermatology residents with hands-on experience in managing biologic therapies for complex psoriasis cases.
Patient Care Regimens: A Model of Comprehensive, Compassionate Care
The clinic’s approach is rooted in rigorous, evidence-based protocols and a commitment to continuity of care. Eligible patients with moderate to severe psoriasis undergo a thorough initial evaluation, including:
• Detailed medical history and physical examination
• Tuberculin skin test and interferon-gamma release assay
• Complete blood count and comprehensive metabolic panel
• Lipid fasting profile and viral hepatitis panel
Once enrolled, patients are seen for follow-up at one month and every three months thereafter. This systematic approach ensures that any potential complications are identified early and treatment regimens are adjusted as needed.
Of the 403 patients seen since the clinic’s inception, 237 (58.8%) have returned for follow-up care, with an average of 3.7 visits per patient across the 20-year period. Two-hundred eight-four (70.5%) received at least one biologic therapy during the 20-year period.
The patients who cannot initiate biologics are managed with alternative therapies.
In a recent analysis of the clinic’s last five years, 62% of patients currently receiving biologic therapy obtained coverage through Medicare, Medicaid or commercial insurance, while 38% accessed treatment through pharmaceutical company patient assistance programs.
Notably, 94.4% of all patients on biologics incurred no out-of-pocket costs, underscoring the effectiveness of both public insurance and manufacturer-sponsored coverage pathways in minimizing financial barriers to treatment.
A Team Effort: Training and Community Impact
The clinic is staffed by a dedicated team: one attending dermatologist (Dr. Romanelli), one clinic coordinator (Mufarrej, whom Dr. Romanelli credits as a significant factor in the clinic’s service and effectiveness), six dermatology residents, three nurses and medical student volunteers. This collaborative environment not only ensures high-quality patient care but also provides invaluable training for future dermatologists in the complexities of biologic therapy management.
The model demonstrates how partnerships between academic institutions, public hospitals and pharmaceutical companies can ensure effective treatment reaches the patients who need it. The clinic has become a viable option for patients who would otherwise go untreated.
Tags: dermatology, Dr. Paolo Romanelli, Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, Health Equity, psoriasis