Beyond the Surface: How New Therapies, Patient-Centered Care Are Changing Psoriasis Outcomes

Psoriasis affects more than 8 million individuals in the US, presenting not only as a cosmetic problem but also playing a profound role on quality of life.1 Advances in systemic therapies, particularly biologics, have substantially improved outcomes for patients with moderate-to-severe disease. Yet access to these transformative treatments remains uneven.2 Beyond clinical efficacy, effective psoriasis management requires attention to the emotional and social impacts of the disease. Research has shown that higher levels of disease acceptance correlate with better quality of life and reduced symptom severity, highlighting the need for patient-centered, interdisciplinary approaches that integrate psychological support with dermatologic care.3 For managed care organizations, these insights underscore the importance of benefit designs and care models that not only facilitate access to advanced therapies but also support holistic, patient-focused strategies that improve adherence, outcomes, and overall well-being.

National Psoriasis Awareness Month offers an opportunity to examine how advances in systemic therapy, combined with patient-centered care models, are reshaping the treatment landscape. | Image credit: Sviatlana - stock.adobe.com

How Psoriasis Treatment Has Evolved

Recent advances in systemic therapy for psoriasis have expanded treatment options beyond traditional biologics, with a growing focus on small-molecule oral and topical drugs that target key immune pathways.4 With the expanding array of systemic therapies, dermatologists are increasingly adopting a patient-centered approach to selecting treatment.

Steven Daveluy, MD, board-certified dermatologist, Wayne State University, highlighted how the evolution of systemic therapies has transformed psoriasis care, making treatment far easier and more effective than in the past. Historically, patients with severe disease faced limited options such as phototherapy, tar applications, methotrexate, or cyclosporine—treatments that were often difficult to manage, less effective, and carried significant risks. Today, dermatologists have access to a wide range of highly effective medications with favorable safety profiles, allowing for more reliable long-term disease control with fewer side effects.

“Now that we have so many highly effective medications that have such great safety profiles, it really is pretty easy to treat even the most severe psoriasis,” said Daveluy, in an interview with The American Journal of Managed Care® (AJMC®).

“My approach is completely patient-centric, so I don't use the same treatment ladder for each patient,” Lauren Eckert Ploch, MD, MEd, FAAD, dermatologist, told AJMC in a written interview. “I discuss the options with my patients to gauge their desire for a systemic vs. topical treatment, and we base our shared decision on how severe their psoriasis and psoriatic arthritis are.”

Clinical decision-making also considers individual risk factors and comorbidities that need to be weighed when tailoring treatment plans for individual patients.

“I look at malignancy history, joint involvement, and extent of skin disease,” explained Ploch. “I also look at other comorbidities (ie, hypertriglyceridemia, heart disease, kidney disease, etc.) and decide from there.”

Improving Patient Access and Education

Despite the substantial improvements in outcomes afforded by biologic therapies, not all patients with psoriasis have equitable access to these treatments. A systematic review of US studies found that disparities in biologics access are influenced by insurance type, race or ethnicity, high out-of-pocket costs, and prior authorization requirements—barriers linked to higher hospital admissions, readmissions, emergency department visits, and treatment delays.2 Beyond these structural challenges, social determinants of health can profoundly affect dermatologic outcomes. During a recent Society for Pediatric Dermatology session, Sarah Coates, MD, FAAD, highlighted how financial hardship, low health literacy, limited access to care, and adverse childhood experiences can worsen conditions such as psoriasis.4

“The biggest hurdle is cost,” emphasized Ploch. “While there are several new topicals on the market, they're completely unaffordable and not often covered by plans like Medicare. Extensive areas are best treated with systemic therapy. It's really difficult to treat full-body psoriasis with a 60 g tube of cream. Insurance coverage is the issue. Some insurances will deny the most appropriate treatment in favor of something else. Sometimes the one they favor is not safe for the patient in question.”

Daveluy echoed this sentiment, emphasizing that one of the biggest barriers to maintaining patients on systemic therapies is not clinical efficacy but logistical challenges such as insurance changes, lapses in coverage, and pharmacy delays. To address these disruptions, his practice works proactively to educate patients about the potential for formulary changes and the need to alert the office immediately if insurance instability occurs. In some cases, medication samples are provided to bridge gaps in coverage, helping patients avoid treatment interruptions. The care team also assists patients in navigating insurance and pharmacy hurdles, though these processes can still be time-consuming and frustrating. By setting expectations early and encouraging open communication, Daveluy noted, patients are better prepared to handle disruptions and more likely to remain engaged with their care, ultimately supporting adherence and continuity of treatment.

"I try to inform patients if they have any sort of insurance instability where maybe they lose it for a while to let us know, because we can often give them samples of the medications to get them through so they don't have to go without and then flare up,” said Daveluy.

Overall, the evolution of psoriasis care demonstrates the powerful intersection of clinical innovation, patient-centered practice, and health system design. With the availability of highly effective systemic therapies, dermatologists are now able to achieve outcomes that were once unimaginable, offering patients long-term disease control with fewer side effects. Yet these advances cannot fully deliver on their promise without addressing the persistent access barriers rooted in insurance design, cost, and social determinants of health.

By aligning coverage with patient needs and supporting interdisciplinary, holistic approaches, payers and providers together can help more individuals with psoriasis achieve meaningful, sustained improvements in both health and quality of life.

References

1. Psoriasis statistics. National Psoriasis Foundation. Updated December 12, 2021. Accessed August 19, 2025. https://www.psoriasis.org/psoriasis-statistics/

2. Wright GC, Okoye GA, Ehrlich AC, et al. US health care disparities in immunology biologics access: a systematic review. Am J Manag Care. 2025;31(8):414-420

3. Steinzor P. How psoriasis acceptance impacts severity, itch, and quality of life. AJMC. January 10, 2025. Accessed August 14, 2025. https://www.ajmc.com/view/how-psoriasis-acceptance-impacts-severity-itch-and-quality-of-life

4. Steinzor P. SPD 2025: Research highlights, personalized treatment, and barriers to care. AJMC. August 4, 2025. Accessed August 14, 2025. https://www.ajmc.com/view/spd-2025-research-highlights-personalized-treatment-and-barriers-to-care