Real-World Impact on People With Psoriasis
While step therapy is designed to control costs, its real-world impact on patients can be significant.
Delays in Effective Treatment Moving from topicals to systemic treatments can take weeks to months, and transitioning to biologics can take even longer due to prior authorizations and insurance requirements, Garshick says.
Daveluy notes that patients may need to try a medication for around three months before insurers consider it a failure, extending the timeline even further.
A study published in 2025 found that step therapy led to delays of more than four months in starting appropriate treatment, required an average of 1.4 additional appointments, and prolonged symptom improvement by roughly 112 days.
Ongoing Symptoms and Flares During that time, patients may be dealing with active disease. “Patients are often flaring with serious psoriasis that impacts their daily life … they may have to settle for a treatment that is less than ideal for their preferences and needs,” Daveluy says.
The stress from ongoing flares, itching, and scaling can take a toll on mental health, too. This is parallel to trying medications patients suspect won’t work and managing insurance paperwork. “While step therapy aims to control costs … it can unintentionally prolong suffering,” Garshick says.
One study found that 52 percent of patients with psoriasis felt “extremely negative” mental health impacts from step therapy.
Administrative Burden Documentation proving a medication failed and appeals processes can be overwhelming for both patients and providers.
The onus is on patients and their doctors to pull together the paperwork needed to make their case to insurance providers, Daveluy says. “Authorizations often need to be renewed each year, even when a treatment is working. That can also cause delays in care that result in flares,” he says.
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