Hospice Pharmacy Insights October 2019

You may have noticed that there has been a significant rise recently in the commercials touting the benefits of the newest generation of plaque psoriasis drugs. Our clinical line has also noticed a rise in calls related to these drugs, especially regarding cost. The following is a list of plaque psoriasis drugs along with approximate retail pricing per month.

Topical medications effective for psoriasis available by prescription include those that contain topical steroids of various potencies. Typical steroid medications are:

• Halcinonide (Halog, Halog-E) – $1200/2 60g tubes
• Flurandrenolide (Cordran, Cordran SP, Cordran Tape) – $915/120ml 0.05% 
• Betamethasone(Luxiq) – $45/45g tube
• Desonide (Desonate) – $275/60g 0.05% tube
• Alclometasone (Aclovate) – $82/60g 0.05% tube
• Mometasone (Elocon) – $50/45g 0.1% tube
• Fluocinonide (Vanos) – $830/60g 0.1% tube
• Triamcinoloneacetonide (Kenalog) – $16/30g 0.1% tube

Tar-containing topicals and vitamin D-like molecules:

• Betamethasone/calcipotriene (Taclonex) $602/60g 0.005%-0.064% tube
• Calcipotriene (Dovonex) $435/60g 0.005% tube

Ultraviolet light administered under controlled conditions in a physician’s office in various wavelengths (narrow-band UVB) with or without supplemental medication (8-methoxypsoralen) (PUVA treatment) is a very effective therapy.

Systemic therapies include:

• Vitamin A-like drug, acitretin (Soriatane) – $569/25mg 30 capsules
• Short-term cyclosporine (Gengraf, Neoral, Sandimmune) therapy for severe flares – $218/25mg 60 capsules 
• Methotrexate (Rheumatrex Dose Pack, Trexall) – $210/5mg 10 tablets
• Apremilast (Otezla) for mild to moderate psoriasis – $4350/30mg 60 tablets

The pricing on the biologicals vary depending on dosing schedule which can be a bit convoluted. One thing all of them have in common is that they are branded and very expensive.

The new targeted drugs called biologics, include: 

• Etanercept (Enbrel) – $5172/month
• Adalimumab (Humira) – $5400/month 
• Infliximab (Remicade) – $2800/month 
• Ustekinumab (Stelara) – $2166/month
• Secukinumab (Cosentyx) – $5416/month
• Ixekizumab (Taltz) – $4200/80mg/ml syringe
• Risankizumab-Rzaa (Skyrizi) – $30,445/75mg/0.83ml 2 syringes

These products are produced by new technologies requiring their synthesis of living cells. They are proteins and all currently must be given by injection at various intervals into the subcutaneous tissue by the patient or by intravenous infusion in a medical facility. They are unique in that they have precise targets in the in the inflammatory pathway that they block. Since the biologics are very, very specific in their mode of action, they claim to offer increased safety and improved efficacy over older less specific immunosuppressive drugs.

All of these treatments must be continued indefinitely because when they are stopped, the psoriasis will typically return. It has recently been appreciated that the presence of psoriasis is a sign of a systemic inflammatory predisposition. Patients with psoriasis are predisposed to being obese, having diabetes, and having a destructive arthritis and premature cardiovascular disease.