Psoriasis typically presents in early adulthood (normally 15 to 25 years of age) and might appear as just a rash or dry skin to most patients. However, this is much more than a cosmetic problem. Psoriasis is a serious autoimmune disease that 7.5 million people live with every day in the U.S.  It is an incurable, chronic disease where skin cells grow at an abnormally fast rate, causing the buildup of psoriasis plaques, or raised red, scaly patches of skin. These patches can cause pain or itching that has a profound impact on quality of life, with nearly 60% of affected patients reporting it being a large problem in their everyday life. Additionally, one-third of patients develop psoriatic arthritis, also an inflammatory condition that causes pain and swelling in the joints and tendons. 
Typical treatments include a combination of topical therapies along with systemic medications, however, 40 to 50% of patients report dissatisfaction with existing treatments.  Over the last three years, there have been dramatic advances in the treatment of psoriasis. Patients are seeing more positive outcomes with these advanced treatments, including reduced itching, less pain and a reduction in the number of areas impacted.
Treatment Developments Provide Hope
New treatments not only result in better outcomes, but also provide patients and physicians with the choice of route of administration and dosing schedule. Historically, these patients only had undesirable treatment options, such as topical coal tar that stained clothing and had a strong odor they couldn’t mask. With these new therapies, patients are given the freedom to choose how and when to take the medication, as well as some control back in an area where there was previously little.
One of the latest developments in psoriasis treatment is interleukin injections. Interleukins are a class of proteins used to regulate immune responses. These long-acting treatments may be preferred by patients because the dosing schedule allows for injections once every three months. These agents also offer patients the hope of complete remission.
The Challenges of Psoriasis Treatment Require Individualized Care
Adherence to treatment is important to reduce psoriasis lesions and improve quality of life, however, maintaining adherence can be a challenge. Most patients are very motivated to take their medication as indicated when starting treatment to eliminate the discomfort and improve their skin appearance. Yet, adherence can become difficult for patients early on when they have not seen a response and they become discouraged about continuing the medication. There can also be a lack of adherence in patients who have achieved optimal response and no longer consider treatment necessary once the lesions have reduced significantly. Patients that only receive treatment intermittently, such as once every three months, also face adherence challenges with remembering the dose or assuming a delay in treatment is acceptable. Taking the medication as directed is vital to long-term success.
Patients with psoriasis and psoriatic arthritis often have other comorbidities, such as depression, cancer, Crohn’s disease, diabetes or heart disease. Managing multiple complex disease states with numerous treatments can also be challenging for patients. Furthermore, psoriasis can be triggered or worsened by external factors, such as stress, smoking, skin injury, infections or even other medications. Being aware of these and having coping strategies are important to reduce psoriasis flares.
A specialty pharmacy that understands these issues and offers individualized care can help patients achieve the best possible outcomes from their therapy.
EnvisionSpecialty Helps Psoriasis Patients Overcome Obstacles
EnvisionSpecialty employs a comprehensive care model to help psoriasis patients on the path to a better quality of life:
- Before the first dose – EnvisionSpecialty pharmacists work with patients before shipping the first dose to ensure they understand their treatment, are ready to start therapy and have proper injection training.
- Financial assistance – To ensure cost is not a barrier for patients, the pharmacy team helps ensure medications are affordable by linking them to copay assistance programs.
- Continual monitoring and communication – Our pharmacists continue to monitor patients throughout treatment to resolve any issues and improve adherence. Drug-specific protocols drive individual interventions that support patients throughout treatment. Resolution of issues can include resetting expectations as to drug treatment response times commonly experienced by patients and encouraging continuous use of topical treatments until the response is achieved. Adherence is supported by encouraging the use of injection calendars, strategic starts, injection training, and patient education to support expectations of treatment and understand the value.
- Listening to the patients – Our pharmacists are trained to listen to patients to ensure we hear the patient voice with respect to their treatment experience. This allows us to assess disease activity level and alter clinical support accordingly.
- Optimizing outcome and waste avoidance – EnvisionSpecialty pharmacists monitor for waste avoidance by ensuring patients are taking treatments as prescribed and are storing and administering them properly. We also evaluate if patients are achieving the desired outcome, and, if not, determine if they should continue treatment.
The individualized care provided to psoriasis patients improves their quality of life while saving patients and plans from unnecessary costs brought by medication waste from discontinuation or missed doses.
 Consumer Health Digest (2018). Psoriasis Awareness Month: Educates Public About the Disease. September 26, 2018. https://www.consumerhealthdigest.com/health-awareness/psoriasis-awareness-month.html
 National Psoriasis Foundation. Statistics. https://www.psoriasis.org/content/statistics