Socioeconomic Status Shapes Access to Advanced Psoriasis Therapies

Patients with psoriasis who live in more socioeconomically deprived neighborhoods are less likely to receive advanced systemic therapies, such as biologics and small molecule inhibitors, compared with those in more affluent areas, according to new findings presented at the Fall Clinical Dermatology Conference 2025 in Las Vegas, Nevada.¹

The analysis, drawn from the CorEvitas Psoriasis Registry, examined the relationship between the Area Deprivation Index (ADI)—a validated measure of neighborhood socioeconomic disadvantage—and treatment patterns among over 7,000 US patients with plaque psoriasis.

Advanced Therapies, Unequal Access

Over the past decade, biologics and small molecule inhibitors have transformed psoriasis management, offering higher efficacy and improved safety compared with traditional systemic agents such as methotrexate, cyclosporine, and acitretin.² However, these newer therapies are often substantially more expensive, potentially creating barriers to access.

Lead author Lauren Miller, PA-C, and colleagues sought to understand whether area-level socioeconomic status influences treatment initiation decisions. Using ADI data linked to patient ZIP codes, they categorized participants into tertiles reflecting low, moderate, and high deprivation.

Among 7,132 patients, 62.1% initiated a biologic, 19.4% began a small molecule inhibitor, and 18.5% received a conventional systemic agent as their first systemic treatment. The average ADI score was 42.9, with higher values denoting greater deprivation.

Clear Gradient of Inequality

The study found a stepwise relationship between neighborhood deprivation and access to advanced psoriasis therapies.

For every 10-point increase in ADI, the odds of initiating an advanced therapy dropped by 8% (OR 0.92, 95% CI 0.90–0.95; p<0.001). Patients in the middle and highest deprivation tertiles had 32% and 42% lower odds, respectively, of starting a biologic or small molecule inhibitor compared with those in the lowest tertile.

This association held true even after stratification by insurance type. Among patients with private insurance, those in the highest ADI tertile were 45% less likely to begin advanced therapy. Among those with public insurance, the reduction was 34%.

"Results from this research support the hypothesis that socioeconomic disadvantage may influence treatment for plaque psoriasis and indicate that patients who reside in areas of higher deprivation may be less likely to initiate an advanced therapy than patients residing in areas of lower deprivation," the authors concluded.

Socioeconomic Barriers Persist Despite Insurance

Although insurance coverage plays a critical role in medication access, the persistence of disparities across insurance categories suggests that additional factors, such as health care literacy, provider availability, and systemic barriers, may also influence treatment decisions.

Call to Action: Addressing Treatment Inequity

The authors concluded that socioeconomic disadvantage may independently influence psoriasis treatment initiation, reinforcing the need for targeted interventions to close the access gap.

Potential solutions include increased provider education, patient navigation programs, and policy efforts to reduce medication costs for underserved populations.

Conclusion

These findings highlight a persistent and clinically meaningful disparity in psoriasis care: patients living in socioeconomically disadvantaged areas are significantly less likely to receive advanced systemic therapies, even when insured. Addressing this gap requires a multifaceted approach, including enhancing provider and patient education, improving access to dermatology care in underserved communities, and implementing strategies to reduce the cost burden of biologics and small molecule inhibitors. By recognizing and actively mitigating the impact of socioeconomic factors on treatment decisions, dermatologists and health care systems can move toward more equitable, patient-centered care for all patients.

References

1. Miller L, Beeghly A, Moore P, et al. Impact of area-level socioeconomic status on access to psoriasis medications in the US. Poster presented at: 2025 Fall Clinical Dermatology Conference; October 23-26, 2025; Las Vegas, NV.
2. Qasem SF, Ashkanani H, Ali A. Therapeutic advancements in the management of psoriasis: A clinical overview and update. Cureus. 2025;17(2):e79097. Published 2025 Feb 16. doi:10.7759/cureus.79097