Biologic Prescribing Patterns Among Mount Sinai Psoriasis Patients: Results of a Retrospective Chart Review

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Alexa Haley Choy
Jonathan Vebman
Christopher Yao


psoriasis, insurance, biologic, ustekinumab, guselkumab, adalimumab, secukinumab, ixekizumab, etanercept, brodalumab, infliximab, prescription


Objectives: Psoriasis is a painful and chronic inflammatory skin condition that not only impacts the quality of life of patients but is also a socioeconomic burden due to the cost of treatment, particularly with biologic treatments. The purpose of the study is to understand biologic prescribing patterns among Mount Sinai psoriasis patients and assess its relationship to insurance policy, which may limit treatment access.

Methods: This study reviewed randomized, de-identified charts of psoriasis patients in a nine physician academic practice at Mount Sinai (New York, United States) with the following insurers: Aetna, Blue Cross Blue Shield, Empire Blue Cross Blue Shield, Medicare A&B, and United Healthcare, treated with the following biologics: secukinumab, etanercept, adalimumab, infliximab, brodalumab, ustekinumab, ixekizumab and guselkumab. A chi-square test was performed to compare prescribed biologics by insurance policy.

Results:  Ustekinumab was the most prescribed biologic treatment across all the insurance plans. There were also disproportionate prescriptions of certain biologics for patients under particular insurance plans. Etanercept, brodalumab, and infliximab were the least prescribed biologics.

Conclusion: Results highlight certain patterns in the prescribed biologics of Mount Sinai patients. Prescribed biologics tend to vary by different insurers. However, ustekinumab was the most frequently prescribed biologic among all insurers, though it is not the most efficacious biologic based on PASI responses.  Future research should be conducted to assess how differences in insurance policies (e.g., cost to patient) affect biologic prescribing.


1. World Health Organization. Global report on Psoriasis. (2016). World Health Organization website.

2. Rachakonda, T. D., Schupp, C. W., & Armstrong, A. W. (2014). Psoriasis prevalence among adults in the United States. J Am Acad Dermatol, 70(3), 512-516.

3. Kaushik, S. B., & Lebwohl, M. G. (2019). Psoriasis: Which therapy for which patient psoriasis comorbidities and preferred systemic agents. J Am Acad Dermatol, 80(1), 27-40

4. Heisler, M., Langa, K. M., Eby, E. L., Fendrick, A. M., Kabeto, M. U., & Piette, J. D. (2004). The Health Effects of Restricting Prescription Medication Use Because of Cost [PDF]. Med Care, 42(7), 626-634.

5. Yao, C. J., & Lebwohl, M. G. (2019). Onset of Action of Antipsoriatic Drugs for Moderate-to-Severe Plaque Psoriasis: An Update. J Drugs Dermatol: JDD, 18(3), 229-233.

6. Food and Drug Administration. Siliq Risk Evaluation and Mitigation Strategy (REMS). (Publication No. 4109073). (2017, June).

7. Doolen, J. National Psoriasis Foundation. FDA approves Taltz for psoriatic arthritis. National Psoriasis Foundation website. (2017, December 1).

8. National Psoriasis Foundation. FDA approves biologic Tremfya for psoriasis. National Psoriasis Foundation website. (2017, July 13).

9. Kaushik, S. B., & Lebwohl, M. G. (2019). CME Part II Psoriasis: Which Therapy for Which Patient Focus on special populations and chronic infections. J Am Acad Dermatol, 80(1), 43-53.

10. Nelson, A. A., Pearce, D. J., Fleischer, A. B., Jr., Balkrishnan, R., & Feldman, S. R. (2008). Cost-effectiveness of biologic treatments for psoriasis based on subjective and objective efficacy measures assessed over a 12-week treatment period. J Am Acad Dermatol, 58(1), 125-135.

11. Sawyer, L. M., Cornic, L., Levin, L. A., Gibbons, C., Moller, A. H., & Jemec, G. B. (2019). Long-term efficacy of novel therapies in moderate-to-severe plaque psoriasis: a systematic review and network meta-analysis of PASI response. J Eur Acad Dermatol Venereol, 33, 355-366.

12. Lasch K, Liu S, Ursos L, et al. Gastroenterologists’ perceptions regarding ulcerative colitis and its management: results from a large-scale survey. Adv Ther. 2016;33:1715–1727.