Medication adherence and health care costs associated with biologics in Medicaid-enrolled patients with psoriasis

Background: Costs and patients' adherence related to biologics are important factors to consider while making informed decisions regarding therapy with biologics in psoriasis management. Objective: To examine predictors of adherence related to biologics, total health care costs, and service utilization among psoriasis patients. Methods: This was a longitudinal cohort study of psoriasis patients (<65 years old) enrolled in North Carolina Medicaid who were prescribed biologics (alefacept, efalizumab, and etanercept). Patients' medication adherence, health care costs, and service utilization patterns in the pre- and post-biologics period were examined. Results: Adherence to biologics was significantly higher compared with the other psoriasis medications (0.66 vs 0.39; p < 0.001). Prescription costs were significantly higher in the post-biologics period ($3796.77 vs $11 706.32; p < 0.001). However, total health care costs in the post-biologics period did not differ significantly from the pre- biologics period ($14 662.22 vs $16 156.10; p > 0.05). Patients' adherence and health care costs did not differ significantly across the biologics. After controlling for other variables, patients had a significantly lower number of hospitalizations in the post-biologics period (p < 0.001). Conclusions: Although costs associated with prescriptions for biologics were higher, total health care costs did not differ significantly in the post-biologics period. Biologics had a better adherence rate compared with other psoriasis medications.