Paying for Psoriatic Arthritis Treatment: Insurance Coverage

Psoriatic arthritis is an inflammatory autoimmune disease that causes symptoms like pain, joint stiffness, and skin lesions called plaques. There are many ways to treat psoriatic arthritis. Cost of treatment depends on several factors like severity of symptoms, what treatments are used, and insurance coverage.

This article covers psoriatic arthritis treatment with private insurance, Medicare, Medicaid, and other methods.

Psoriatic Arthritis Treatment Options

Psoriatic arthritis treatment options can include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These are anti-inflammatory drugs for pain and swelling. They can be over-the-counter⁠ (OTC), like Advil (ibuprofen) or Aleve (naproxen), or prescribed, like Celebrex (celecoxib). NSAIDs can also come in a topical (on the skin) formula, like Voltaren (diclofenac).
• Disease-modifying antirheumatic drugs (DMARDs): DMARDs are anti-inflammatories that are stronger than NSAIDs. They are used to slow down the disease and can put it in remission. Methotrexate is the most commonly prescribed DMARD for psoriatic arthritis.
• Corticosteroids: Steroids that can be injected or swallowed for fast pain relief. Corticosteroids are often used for short-term treatments because of the potential for long-term side effects.
• Biologics: Biologics are solutions that block the production of proteins that cause inflammation. They are injected or infused into the bloodstream via intravenous (IV) therapy. Biologics are an expensive option, but they are more effective in keeping inflammation at bay and can result in long-term savings.

Psoriatic Arthritis Treatment Costs

Psoriatic treatments can range from low cost to expensive, depending on the severity of the patient's condition. One study on patients newly diagnosed found that after a year:

• For patients taking oral medications, including DMARDs, the total cost ranged from about $1,000 to $1,500, including $300 to $550 on prescription medication.
• For patients prescribed biologics, costs can range from about $4,000 to $7,000, with about $200-$4,000 spent on prescription medication.

Other costs associated with psoriatic arthritis might include OTC medication and mobility devices, which may include things like canes, walkers, bed assists, and wheelchairs. Prices can range from about $30 for a cane to $100 for a walker. Wheelchair prices can range from about $100 to $1,000 and more, depending on style. Insurance does cover some mobility devices.

Does Insurance Cover Psoriatic Arthritis Treatment?

The Affordable Care Act (ACA), which was signed into law in 2010, states that people cannot be denied insurance or be charged higher premiums because of arthritis. However, the degree of coverage for psoriatic arthritis can depend on individual circumstance and insurance company rules.

Medicare

Medicare is the federal health insurance program for people over age 65, some people with disabilities, and people with end-stage renal disease.

Medicare does cover treatments and medications for psoriatic arthritis. To help with costs, it might help to speak to your healthcare provider about:

• Marking biologic infusion treatments as medical procedures under Medicare part B
• Patient assistance programs (PAPs), which provide financial help based on income

Medicare also covers mobility aids like canes, walkers, and lifts at a cost of 20% after yearly deductibles for Medicare part B are paid. You can also supplement Medicare coverage with Medigap, which is supplemental insurance purchased through private insurers.

Medicaid

Medicaid is a federal- and state-funded healthcare program for low-income adults and children. A person can be eligible for Medicaid and Medicare at the same time. Eligibility can depend on state, and it considers factors like income, age, and family size. Medicaid enrollment can include:

• Income-based drug coverage
• Federal enrollment fee limits for "medically needy individuals"
• No-cost emergency department visits

Applying for Medicaid can be done through the healthcare marketplace or a state's specific Medicaid application site.

Private Insurance

Private insurance companies are required to cover arthritis treatment. When insurance doesn't cut it, there are programs that can supplement care, such as:

• Co-pay cards
• Patient assistance programs (PAPs)
• Federally qualified health centers
  

Insurance Coverage Obstacles

Insurance coverage obstacles that people with psoriatic arthritis face can include:

• High co-pays and out-of-pocket costs
• High costs for more effective therapies, like biologics
• Long-term treatment schedules that can be difficult to maintain
• Step therapy requirements, in which a patient must try other medications before trying biologics. (i.e., paying for several less-expensive treatment options to avoid paying for an expensive one)
• Denial for coverage for biologics by insurance companies
• Lapses in treatment when moving or changing insurance plans

Even milder cases of psoriatic arthritis may also see treatment barriers. Researchers have found mild cases of psoriatic arthritis need better treatment to prevent the worsening of symptoms of the disease.

Summary

Insurance programs are required to cover arthritis treatment, however, psoriatic arthritis treatment can be costly. Much of this can depend on whether a patient is using oral or topical medications vs. biologic injections. Insurance companies might also reject patient requests for biologic treatments until other drugs are tried beforehand.

Other difficulties insured psoriatic arthritis patients face include high co-pays and out-of-pocket costs, lapses in care when switching insurance plans, long-term care that can be difficult to maintain, and treatment barriers for mild psoriatic arthritis that can progress into a more severe form.

A Word From Verywell

Psoriatic arthritis can be a painful condition, and paying for treatment can seem overwhelming. While insurance is required to cover arthritis treatments, the condition can still be costly, especially when prescriptions are required. No matter how mild your psoriatic arthritis might seem, you deserve complete care considering the disease could progress into something more difficult over time.