Background: The purpose of this retrospective, observational study was to identify and characterize geographic barriers to, and disparity in, access to care for patients with psoriasis in the United States.
Methods: The study utilized STATinMED’s all-payer database of commercial, Medicaid, and Medicare claims between January 1, 2014, and December 31, 2020. Adult patients who had ≥1 diagnosis claim for psoriasis (index) and ≥1 claim for advanced therapy (apremilast or biologics) between January 1, 2015, and December 31, 2019, together with ≥12 months of pre- and post-index continuous capture, were included. Patients were assigned a 3-digit ZIP code prefix (zip3) based on their most frequent primary care healthcare provider (HCP) during the study period; their psoriasis-treating HCP’s zip3 was also identified. Health Resources and Services Administration definitions determined whether each zip3 was urban or rurally located.
Results: The sample included 179,688 patients, approximately half (51.1%) of whom had commercial insurance, 39.9% Medicare coverage, and 6.8% Medicaid. The Southern region had the highest number of patients in the study (40.0%), and the West had the least (12.0%); 20.0% of patients lived in a rural area and 80.0% in an urban area. Urban areas had a high density of psoriasis-treating HCPs; only 1.7% of patients traveled outside their zip3 for psoriasis-related care. In rural areas, 74.8% of patients sought psoriasis-related care outside their zip3, suggesting limited local access to dermatologic specialty care.
Conclusion: Rural areas have limited access to psoriasis-treating providers who prescribe advanced therapies, indicating geographic disparities in care.