Patient Perspective: Cost, Comorbidities, and Dosing in Psoriasis Care

"Patient Perspective: Cost, Comorbidities, and Dosing in Psoriasis Care" closes out the program with Keki Mody's reflections on cost, comorbidities, and what he wishes clinicians understood.

Keki Mody continues his account, describing how psoriasis affected him emotionally more than functionally. He could conceal plaques on his legs, hands, and chest under normal clothing and rarely felt limited at work, where he always wore suits, though he avoided shorts and felt self-conscious at the beach. The disease bothered him most privately, at home, where he describes repeatedly wondering when it would finally go away. Dr. Bunick highlights how heavily cost weighed on Mody's decisions, and Mody confirms it weighed on him significantly. He recalls finally telling Bunick he was willing to pay thousands of dollars out of pocket for risankizumab before Bunick redirected him to tildrakizumab, covered under Medicare Part B.

Bunick explains his own decision-making principle: asking what he would recommend if the patient were a family member, rather than defaulting to the most expensive option when an effective, covered alternative exists. Mody describes his concurrent MGUS diagnosis, now characterized as smoldering myeloma, and explains that his rheumatologist actively supported an IL-23 inhibitor partly because of possible benefit in slowing MGUS progression. His monitoring frequency has since decreased from every three months to twice yearly after years of stable lab results.

On dosing frequency, Mody says monthly secukinumab was never burdensome because shipments arrived automatically but given a choice he would still prefer every-12-week dosing. He encourages other patients with psoriasis to pursue biologic therapy, contrasting his outcome with friends who suffered visibly for years unnecessarily. He also notes that other older patients, including his own wife, experience significant anxiety before appointments, and that mobility-limited patients can face real difficulty simply reaching a treatment facility for administration.

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