OBJECTIVES: To identify and characterize geographic disparities in access to psoriasis (PsO) care for Medicaid patients.

METHODS: Adults (≥18 years) using Medicaid insurance were identified from RWD Insights retrospective claims database from 1/1/2015-12/13/2019. Included patients had ≥1 claim for a PsO indicated medication after the first PsO diagnosis (index date), and if they had ≥12 months of continuous capture before/after index date. Demographic characteristics were assessed during the 12-month pre-index period. Patients were assigned a zip3 through the location of their most frequently visited primary care provider during the study period. Zip3s were identified as urban or rural using the Health Resources and Services Administration (HRSA) Rural Assignment Identifiers. If no provider was identified, patients were considered rural. The number of PsO-treating providers in each patient’s zip3 were identified and designated as urban or rural. Access to care was determined by the number of patients with 0, 1-2, 3-4, 5+ providers in their zip3.

RESULTS: 12,247 PsO patients had a Medicaid health plan. Corticosteroids, followed by methotrexate, were the most common treatments for PsO patients (89.57%, 11.72%) during the 12 months after index. In rural areas, 69.29% of patients had no access to PsO treating specialties, while in urban areas, only 2.82% had no access to PsO treating specialties. 53% of urban and 12% of rural patients had 5+ family practices in their zip3. Only 34% of urban and 6.9% of rural patients had 5+ dermatologists in their zip3. Top states with patient access to psoriasis-related dermatology care were Rhode Island, Nevada, Florida, Maryland and Utah.

CONCLUSIONS: Medicaid patients have limited access to specialty care. The majority of rural patients sought care in urban areas due to a lack of access to advanced care, while urban patients sought care outside of their zip3 because of Medicaid insurance limitations.