360 Factors in topical steroid selection: A qualitative study

Abstract

Biologic therapy is associated with better outcomes for moderate to severe psoriasis compared to systemic or topical therapies. Do prescription patterns in a national expenditure database identify gaps in financial assistance and equity in optimal care delivery? To determine the degree to which adults below the federal poverty level (FPL) are prescribed biologics, we performed a retrospective cross-sectional study using pooled data from the Medical Expenditure Panel Survey (MEPS). A prescription was defined by a biologic Multum Lexicon code linked to a psoriasis ICD code. Demographics and biologic prescriptions were compared between psoriasis patients below versus at or above the FPL using weighted-subject designs. We identified 1,437,792 yearly-weighted patients with active psoriasis (1,356 total unweighted) between 2007 and 2018, of whom 123,392 were below the FPL (166 total unweighted). Psoriasis patients below the FPL were less likely to be prescribed biologics for psoriasis than psoriasis patients at or above the FPL (5% vs 12%, p¼0.01). In addition, they were more likely to be black (p¼0.02), be formerly or never married (p<0.001), have public or no insurance (p<0.001), have no degree (p¼0.02), and self-report poor/fair physical or mental health (p<0.001). Finally, psoriasis patients below the FPL taking biologics had lower median biologic medication expenditures per person than psoriasis patients at or above the FPL taking biologics ($6,511 vs. $12,152, p¼0.003). Biologics are not prescribed equally among all socioeconomic cohorts, notably across racial and socioeconomic strata such as black patients and patients with no degree. Further studies are needed to identify the financial assistance programs that best address the persistent hurdles to equity in the delivery of holistic care in the United States.