David M. Pariser, MD
Professor, Department of Dermatology, Eastern Virginia Medical School, Norfolk, Va.


Plaque psoriasis, also referred to as psoriasis vulgaris, afflicts upwards of seven million Americans (Koo 1996). Because psoriasis is a cutaneous disorder, many have underestimated its medical impact (Weiss 2002). Nevertheless, many patients are hospitalized each year due to complications related to psoriasis and its treatment, and approximately 350 patients die annually from related causes. The overall costs associated with psoriasis management are significant, possibly exceeding $3 billion annually (National Psoriasis Foundation 2001).

Because the manifestations of psoriasis are obvious and visible, this disease has a profound psychosocial impact. Notably, the results of a questionnaire revealed that patients with psoriasis reported reduction in physical and mental functioning similar to that observed in patients with other major medical illnesses, including cancer, arthritis, hypertension, heart disease, diabetes, and depression (Rapp 1999).

In the last decade, a new understanding about the pathophysiology of psoriasis has resulted in the development of a new class of agents for these patients: targeted biologic therapy. These novel treatments target specific immunologic processes involved in the genesis of this disease, providing significant clinical benefit to psoriasis sufferers. The American Academy of Dermatology (AAD) Consensus Statement places biologic therapies among the currently approved systemic treatments for patients with widespread disease.

Author correspondence:
David M. Pariser, MD
Professor, Department of Dermatology
Eastern Virginia Medical School
601 Medical Tower
Norfolk, VA 23507
Phone: (757) 622-6315
FAX: (757) 623-7039
E-mail: info@pariserderm.com

This paper has undergone peer review by appropriate members of Managed Care's Editorial Advisory Board.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.