Discontinuation of treatment
- Giving up on disease treatment1
Access to healthcare1
Access to healthcare is an important issue for various communities and different backgrounds. It is essential for HCPs to recognize the potential barriers patients may face, including language barriers, financial constraints, and lack of awareness about available resources.
Key principles
Understand the barriers patients face when accessing care
Explore effective ways to support patients from different backgrounds
Barriers to Care1-6
Insurance limitations
- Insufficient insurance coverage (eg, high-deductibles, gaps in coverage)
- Prescription drug coverage requirements (eg, step therapy protocols, prior authorization)
- Inadequate provider networks
- Limitations on access to specialists1
Care coordination challenges
- Being prescribed medications that may interact
- Difficulty getting refills1
Appointment accessibility
- Difficulty scheduling appointments
- Finding time to go to appointments1
Travel challenges
- Travel to appointments may be long, stressful, costly, and uncomfortable1
Lack of social and emotional support
- Inadequate support for coping with serious chronic illness2
- Insufficient mental health resources
Limited availability of specialty care
- Lack of health services and providers in the rheumatology specialty care services3,4
Technology barriers
- Lack of access to technology or internet with the increased use of telehealth methods5
Historical distrust
- Ongoing distrust of the medical community among certain communities6
Content informed and developed with input from people living with PsA and an expert steering committee. The items above are not an all-inclusive list and may not apply to all patients living with PsA.
Patient support tips
Tips to support people living with PsA in accessing and optimizing care:
Patient navigation services
Offer patient navigation services, as possible, to help overcome healthcare system barriers.
Utilize patient advocates
Engage patient advocates to assist individuals living with PsA.
Referrals to support groups
Provide referrals to patient support groups, including those serving various backgrounds.
Decision support tools
Offer decision support tools to assist with patient decision-making.
Content informed and developed with input from people living with PsA and an expert steering committee.
Insurance knowledge gaps7,8
Navigating insurance and the healthcare system can be difficult, especially for individuals who face:
Language barriers
Unfamiliar health insurance systems from their countries of origin
Health literacy challenges
Patients prescribed certain medications may need to obtain them from specialty pharmacies. These pharmacies provide treatments for complex medical conditions like PsA and offer specialized services, including:
Prior authorization assistance
Individualized follow-up care
Addressing insurance knowledge gaps is crucial in effectively managing PsA, as it can significantly impact a patient’s ability to access care and medications.
Healthcare professional checklist for insurance support
The checklist below outlines some suggested items healthcare team members should consider when handling patients’ insurance.
Assess understanding of insurance coverage*
Determine the patient’s understanding of their insurance plan, including what is covered, the costs they are responsible for, and how to navigate the approval process for tests and treatments.
Identify language barriers
Confirm whether the patient requires translation services for insurance documents and during discussions with insurance representatives.
Educate on the basics of insurance†
Provide clear explanations about premiums, deductibles, co-pays, coinsurance, out-of-network charges, and how these may affect the patient’s care.
Explain the role of insurance in PsA care
Describe how insurance can affect access to specialists, procedures, medications, and ongoing care.
Clarify medication coverage‡
Discuss formulary restrictions, generic vs brand medications, and the process of obtaining approvals for certain PsA medications.
Highlight the importance of maintaining coverage
Educate on the potential financial and health consequences of lapses in insurance coverage.
Guide on insurance appeals§
Provide information on how to navigate denials and appeals.
Navigate public assistance and supplemental programs
Assist in understanding public insurance options and supplemental programs for which they may be eligible.
Address cultural views on insurance and health care
Recognize and discuss any cultural beliefs that may impact the patient’s approach to insurance and healthcare utilization.
Connect with social workers or patient navigators
Refer patients to social workers or patient navigators who specialize in assisting with insurance-related issues.
Notes for HCPs
- *If unsure about the specifics of the patient’s insurance, guide patients on where to find this information (eg, insurance customer service, insurance website).
- †Use educational materials or refer to insurance specialists who can provide detailed explanations.
- ‡You may not know the specifics of the patient’s coverage; therefore, encourage patients to contact their insurance provider or pharmacy for detailed information.
- §Refer patients to insurance advocates or resources that can help with the appeals process.
Co-pay
- Co-pay is a flat fee paid by a patient in order to access healthcare services
Co-pay accumulator
- Co-pay accumulator is a feature within an insurance plan where a manufacturer’s payments do not count toward the patient’s deductible and out-of-pocket maximum
- The manufacturer co-pay card funds prescriptions until the maximum value on the card is reached
- After that, the patient’s out-of-pocket costs begin counting toward their annual deductible and out-of-pocket cost maximum
Co-pay adjustment program
- This can either be a co-pay accumulator or co-pay maximizer
Co-pay card
- A co-pay card, sometimes called a co-pay coupon, is financial assistance that helps patients with insurance afford prescription medications by covering part or all of a member’s deductible and co-pay
Co-pay maximizer program
- A co-pay maximizer program is within an insurance plan where a manufacturer’s payments does not count toward the patient’s deductible and out-of-pocket maximum
- The maximum value of the manufacturer’s card is applied evenly throughout the benefit year
Cost sharing
- Cost sharing includes the share of costs covered by insurance that a patient pays out of their own pocket
- This term generally includes deductibles, coinsurance, and co-payments, or similar charges, but it does not include premiums, balance billing amounts for non-network providers, or the cost of non-covered services
Explanation of benefits
- Shows the total charges for a visit and is not a bill
- Helps the patient understand how much their health plan covers, and what they will pay when they get a bill
Deductible
- A deductible is an amount an insured party pays out-of-pocket before an insurance company pays a claim
Out-of-pocket costs
- Out-of-pocket costs include expenses for medical care that are not reimbursed by insurance, including deductibles, coinsurance, and co-pays for covered services plus all costs for services that aren’t covered
Content informed and developed based on a targeted literature review and input from a steering committee of psoriatic arthritis (PsA) specialists, PsA practice administrators, and individuals living with PsA.
Related patient resources
Paying for treatment
The National Psoriasis Foundation provides information on the cost roadblocks associated with psoriatic arthritis treatments and medications. This webpage provides information on:
- Health Insurance
- Medicare Resources
- Financial Assistance
- Overcoming Common Insurance Hurdles
Find a support group
The National Psoriasis Foundation provides information on finding a support group for individuals with PsA. This webpage emphasizes the importance of connecting with others who share similar experiences and offers a search tool to locate local support groups.
Patient navigation center
The National Psoriasis Foundation resource provides dedicated resource for patient navigators. Navigators can help you:
- Find a healthcare provider
- Learn about psoriatic disease and your treatment options
- Understand how health insurance works
- Learn about programs that may lower the cost of treatments
- Connect patients and caregivers to other people living with psoriatic disease.
- Bhutani T, Wong JW, Bebo BF, et al. Access to health care in patients with psoriasis and psoriatic arthritis: Data from National Psoriasis Foundation survey panels. JAMA Dermatol. 2013;149(6):717-721. doi: 10.1001/jamadermatol.2013.133
- Leung YY, Tam LS, Lee KW, et al. Involvement, satisfaction and unmet health care needs in patients with psoriatic arthritis. Rheumatology (Oxford). 2009;48(1):53-56. doi:10.1093/rheumatology/ken410
- Miloslavsky EM, Bolster MB. Addressing the rheumatology workforce shortage: A multifaceted approach. Semin Arthritis Rheum. 2020;50(4):791-796. doi: 10.1016/j.semarthrit.2020.05.009
- American College of Rheumatology Committee on Rheumatology Training and Workforce Issues, FitzGerald JD, Battistone M, Brown CR Jr, et al. Regional distribution of adult rheumatologists. Arthritis Rheum. 2013;65(12):3017-3025. doi: 10.1002/art.38167
- Gottlieb AB, Wells AF, Merola JF. Telemedicine and psoriatic arthritis: Best practices and considerations for dermatologists and rheumatologists. Clin Rheumatol. 2022;41(5):1271-1283. doi: 10.1007/s10067-022-06077-3
- Arthritis Foundation. Arthritis in the Black Community. Accessed May 22, 2026. https://www.arthritis.org/getmedia/bcb70c73-0351-47e1-ac22-399b6ca1271b/AA_Wellness_Guide.pdf
- National Psoriasis Foundation. Paying for Treatment. Accessed May 22, 2026. https://www.psoriasis.org/paying-for-treatment
- Cavalier D, Doherty B, Geonnotti G, et al. Patient perceptions of copay card utilization and policies. J Mark Access Health Policy. 2023;11(1):2254586. doi:10.1080/20016689.2023.2254586