Medicare and Psoriasis: Coverage, Treatment, Medications & More
August is National Psoriasis Awareness Month, and it’s important for the patients to know they are not alone. Psoriasis can be one of the most annoying and embarrassing skin conditions. While researchers have worked relentlessly to find out what causes psoriasis, many facets of it are still unknown. You have questions, and we have answers to fill in some of the top concerns regarding Medicare and psoriasis.
Does Medicare cover Psoriasis treatment?
Medicare is split into four parts. Part A, B, C, and D. The answer to the question isn’t as simple as yes or no. It depends on your prescribed treatment and what Medicare plan you have. A good starting point is to determine if the FDA approves a treatment. That will be a requirement for any hope of coverage.
Check the medicine and pricing average from the Centers for Medicare and Medicaid
Medicare Part B will help with the costs of diagnosing psoriasis and in-office treatments, while Medicare Part D helps cover the costs of prescription drugs and medicine. Notice the word “helps.” One of the top complaints about Medicare coverage in 2022 is the high out-of-pocket costs for psoriasis medications, even when covered.
As medical scientists work to find a cure, several treatment options exist for the different variations of psoriasis.
- Skin Creams: An ointment, lotion, or cream applied directly to plaque or rash sites.
- Injections: Steroid injections directly into the site of the outbreak.
- IV/Biologics: Medication is provided through an intravenous port into the veins.
- Light Therapy: Exposure to controlled amounts of light. This could be done at a doctor’s office or at home.
There are also alternative medicinal options, including fish oil supplements, aloe, and barberry. Speak with your medical provider before trying alternative medicine.
Step-by-step guide to Psoriasis medications covered by Medicare
Don’t be too excited when you hear about a possible new treatment for psoriasis on TV or on the internet. A few simple steps can help you be better educated before talking to your doctor about treatments covered through Medicare.
- The medication must be FDA approved before there can be any hope that Medicare will cover it.
- The Centers for Medicare and Medicaid (CMS) is a great starting point for researching information.
- Certain health impacts must be present for some medications to be covered. For example, a person has a limited range of motion because of psoriasis.
What Psoriasis treatments are covered by Medicare?
As a general rule, a patient must have moderate to severe psoriasis before medications rise to be a Medicare-approved option.
- Skin Creams: Over-the-counter options like CeraVe and Curel won’t have you dipping into your Medicare plan. The prescription creams should be covered by Medicare Part D.
- Injections/Biologics: These should fall under Medicare Part B since it’s performed during an appointment with a doctor.
- UV Light/Phototherapy: UVA and UVB light treatments are traditionally covered. A newer treatment using a drug/light combo called PUVA is covered, but only when other treatments have proven unsuccessful.
What Psoriasis treatments are not covered by Medicare?
You won’t be able to get reimbursed for the charges associated with over-the-counter medication, like the creams and lotions.
It’s important to note that even if the Medicare booklet lists certain medications with codes and pricing, there’s a clear disclaimer at the top:
“The absence or presence of a HCPCS code and the payment allowance limits in this table does not indicate whether Medicare covers a drug. These determinations shall be made by the local Medicare contractor processing the claim.”
Other factors can lead to cost questions associated with Psoriasis:
- Mental Health: The appearance of psoriasis can impact the mental health and socialization habits of patients, leading to patients seeking mental health. These services would be covered under Medicare Part B.
- Emergency Services: Some variations of psoriasis can lead to emergency room visits, which would be covered under Medicare Part D with a co-insurance payment. If your doctor admits you to the hospital within three days, the co-insurance payment could be dropped as inpatient treatment is covered by Part B.
- Adaptability: Medicare covers assistance tools like walkers and canes, which can be needed if psoriasis limits mobility, but only if your doctor prescribes it.
Does Medicare cover biologics for Psoriasis every time?
When choosing a doctor to treat psoriasis with IVs or injections, ask if the office has a Biologics Coordinator. This person will be an advocate between the patient and Medicare, pushing for ongoing coverage for this helpful treatment.
Does Medicare cover phototherapy for Psoriasis every time?
The key to being approved for light therapy or phototherapy is that it must be medically necessary. It cannot be for vanity or cosmetic reasons. A doctor must prescribe and accept the Medicare assignment to make this procedure covered.
Psoriasis (suh-RYE-us-sis) comes from the Greek word “psora,” meaning “itch.” The hallmark of a psoriasis outbreak is patches of distorted skin, either looking like a wound, rash, or growth.
More than 7.5 million adults in America and 125 million people globally struggle with this condition. That’s 3% of the population and growing.
There are five variations of psoriasis:
- Plaque: A collection of skin cells that form scaly sections of raised skin. This painful and itch-inducing version can also turn into a wound, as it easily can lead to cracking and bleeding.
- Guttate: Red rashes are small but numerous and can cover certain body parts.
- Pustular: These pus-filled bumps, either white or red in color, are called “pustules.”
- Inverse: Attacks the areas where the skin folds, like armpits and groin areas. The smooth red patches can be exacerbated by sweat, bacteria, and other bodily fluids in these regions.
- Erythrodermic: This version is somewhat of a mix of all the above and is generally the most dangerous. A body can feel like it’s one fire with a large portion of the body covered in scales above bright red rashes.
Psoriatic arthritis doesn’t just affect your skin, but it attacks your joints as well, similar to osteoarthritis and rheumatoid arthritis. One in three psoriasis patients is at risk of developing psoriatic arthritis.
Who is at risk of getting Psoriasis?
Psoriasis doesn’t have a “type.” Anyone of any age or ethnicity could get it. While it’s more common to see first symptoms in the decade between 15 years old and 25 years old, there’s no limit. Guttate psoriasis is more likely to form in people under 18 years old after a bout with a strep infection.
What causes Psoriasis?
It stems from the immune system. A hyperactive immune system rapidly produces skin cells for reasons not entirely medically understood. While the average person will grow and shed these skin cells, people living with Psoriasis don’t shed the cells. Instead, they form a stack of skin known as “plaque” on various body parts.
There is also a genetic connection, but even that part is relatively misunderstood. Having a family history doesn’t mean you’ll get it and having no family history doesn’t mean you won’t.
While the immune system anomaly is the start, outbreaks can be triggered. This means an action or experience that causes a flare-up.
- Skin Trauma: As part of what’s called the Koebner Phenomenon, any trauma—accidental or intentional—can spur an outbreak. This could be anything from a patient getting their ears pierced or a mosquito bite, to scraped skin after falling down.
- Stress: This is a “which came first” scenario where life stressors can cause a flare-up, and the flare-ups, in turn, cause more stress.
- Cold Weather: Cold air generally means drier air, which leads to less skin moisture. Dry skin can crack and bleed, making the outbreak more painful and challenging to manage.
- Smoking & Drinking: Many people notice outbreaks after binge drinking and exposure to or use of cigarettes and related smoke. Alcohol can also interfere with medications to treat psoriasis.
Can Psoriasis be cured?
There is no cure for any psoriasis variations, but there are numerous ways to manage the pain of an outbreak and limit future outbreaks. You can also focus treatment on reducing the appearance of skin lesions.
Supporting Kansans with Medicare and Psoriasis treatment
Nothing about psoriasis is simple, and you need someone on your side to help keep the costs down while maximizing treatment options. Contact Blue Cross and Blue Shield of Kansas through the website or call 1-800-432-3990 to get a compassionate and dedicated ally.