Clinical Scorecard: The High Cost of Medication: How a Copay Card Assisted Until It No Longer Did

At a Glance

Key Highlights

• Otezla is an expensive brand-name medication with a list price around $5,000 per 30-day supply.
• Copay assistance programs can temporarily shield patients from high out-of-pocket costs but may be exhausted quickly.
• Insurance plans may not count copay assistance toward deductibles or out-of-pocket maximums, leading to unexpected patient expenses.

Guideline-Based Recommendations

Diagnosis

• Refer patients with skin and joint symptoms to rheumatology for evaluation and diagnosis of psoriatic arthritis.

Management

• Consider Otezla for controlling symptoms of psoriatic arthritis when indicated.
• Enroll eligible patients in manufacturer copay assistance programs to reduce initial financial burden.

Monitoring & Follow-up

• Monitor patient adherence and symptom control, especially if medication dosing is altered due to cost concerns.

Risks

• Risk of symptom relapse if medication is rationed or discontinued due to cost.
• Potential financial toxicity from high out-of-pocket costs once copay assistance is depleted.

Patient & Prescribing Data

Patients with psoriatic arthritis prescribed Otezla

Copay cards may cover a limited amount annually (e.g., $9,450) but can be exhausted within months, leading to significant out-of-pocket expenses despite insurance coverage.

Clinical Best Practices

• Educate patients about the potential limitations and expiration of copay assistance programs.
• Coordinate with insurance and pharmacy benefit managers to clarify negotiated drug prices and patient responsibilities.
• Encourage patients to plan financially for medication costs beyond copay assistance coverage.
• Avoid medication rationing to prevent symptom recurrence and disease progression.
• Consider alternative therapies or generic options where available and clinically appropriate.

References

• GoodRx Drug Pricing for Otezla
• FDA Approval of Otezla and Generic Status