Healthcare experts are voicing for revisions in the management of psoriasis, a non-infectious, chronic inflammatory skin ailment stemming from immune system irregularities.
Currently, biologics—remarkably potent yet costly treatments—are reimbursed according to the extent and severity of psoriasis-affected regions.
However, given the challenging nature of psoriasis treatment, even in limited areas, and its substantial impact on patients' quality of life, experts are urging the government to lower the reimbursement threshold for biologics in psoriasis cases.
"Lowering the reimbursement threshold for biologics in psoriasis is imperative due to its challenging treatment nature and substantial impact on patient's quality of life," emphasized Kim Dong-hyun, a dermatology professor at CHA Bundang Medical Center. He shared this perspective during Janssen Korea’s Masterclass on “Quality of Life and Recent Advances in Patients with Palmoplantar Pustulosis and Exposed Psoriasis” held on Tuesday.
Psoriasis occurring in exposed areas like the hands and face differs inherently from psoriasis in covered regions of the body. Beyond enduring discomfort and itching, patients also grapple with additional challenges like unwelcome stares and diminished self-esteem.
Uncovered areas affected by psoriasis are frequently regarded as challenging to manage, given the tendency for psoriasis prevalence to escalate alongside its severity, as stated by Kim. He highlighted that exposed psoriasis-prone regions frequently experience flare-ups and persistent lesions, even after undergoing multiple treatments, compounding the distress for patients.
The scalp, face, hands, and feet represent the most agonizing areas for individuals grappling with psoriasis.
"Patients bearing psoriasis in these regions encounter challenges securing employment and face relationship difficulties," Kim said. "They consistently experience a diminished quality of life in comparison to those without visible psoriasis, underscoring the necessity for effective treatment."
"It is ironic that these patients have to pay more for treatment because they are not covered," says Dr. Kim, adding that the problem is serious enough that the Korean Psoriasis Society published its first expert consensus on psoriasis treatment this year to improve the treatment environment.
Kim highlighted the irony that such patients end up paying more for their treatment because of non-reimbursement.
To resolve this issue, the Korean Society for Psoriasis (KSP) recently published its inaugural expert consensus on psoriasis treatment.
The expert consensus, developed by 61 members of the KSP, states that "biologics can be used to treat localized psoriasis lesions (scalp, face, nails, genitals, etc.) that are associated with significant functional decline and high levels of distress.” In particular, dermatologists emphasized that the treatment environment for pustular psoriasis, such as pemphigus vulgaris, should be improved, as psoriasis with pustules is more severe than psoriasis without pustules.
Professor Kim Byung-soo of dermatology at Pusan National University Hospital said even a small amount of psoriasis has a serious impact on patients if it occurs in exposed areas, and it is much more painful if pus is collected.
He also noted that drug costs for patients with palmoplantar pustulosis to use biologics are six times higher than those of moderate psoriasis patients with more than 10 percent of the total skin area who meet the criteria for insurance benefits.
Moreover, even though palmoplantar pustulosis is an infrequent condition, it does not hold an official classification as a rare disease. Consequently, it does not qualify for the 90 percent medical cost discount that is applicable to patients diagnosed with officially recognized rare diseases.