OBJECTIVES: To characterize patterns of pharmacologic care for the treatment of moderate-to-severe psoriasis. METHODS: Using 10 years (June 1, 1997 to July 31, 2007) of Florida Medicaid administrative claims, we identified the first documented psoriasis diagnosis ("index diagnosis") among adult (aged ≥18 years) enrollees. "Targeted treatments," those FDA-approved for psoriasis by June 30, 2006, were oral systemics (acitretin, cyclosporine, methotrexate) and biologics (alefacept, efalizumab, etanercept). Patients in "active treatment" received ≥2 fills of the same targeted treatment within 45 days during the year following index diagnosis. RESULTS Among 3,137,110 adult enrollees, 7,571 (0.24%) received an index diagnosis of psoriasis. Of these, 173 (2.3%) patients received active treatment; they were predominantly female (67.6%) and Caucasian (50.3%). There were 54 (31.2%) patients aged 18-39 years, 81 (46.8%) aged 40-59 years, and 38 (22.0%) aged ≥60 years. Among those actively treated, 63.6% (110/173) received oral systemics [24.3% (42/173) acitretin, 3.0% (3/173) cyclosporine, 37.6% (65/173) methotrexate], and 51.4% (89/173) biologics [0% (0/173) alefacept, 0.6% (1/173) efalizumab, 50.9% (88/173) etanercept]. Mean (SD) doses were: acitretin 26.6 (11.0) mg/day, cyclosporine 130 (61.0) mg/day (equivalent to 1.5 and 1.7 mg/kg/day for average males and females in the United States, respectively), methotrexate 17.5 (14.7) mg/week, and etanercept 67.2 (26.6) mg/week; alefacept and efalizumab had insufficient data for analysis. Median doses were: acitretin 25 mg/day, cyclosporine 100 mg/day (equivalent to 1.1 and 1.3 mg/kg/day for average U.S. males and females, respectively), methotrexate 14.7 mg/week, and etanercept 49.7 mg/week. Eighty-one percent of patients received acitretin ≤25 mg/day, 67% received cyclosporine ≤100 mg/day, 72% methotrexate ≤17.5 mg/week, and 54.5% etanercept ≤50 mg/week. CONCLUSIONS: Although the number of treatments for moderate-to-severe psoriasis is burgeoning, little is known about patient characteristics and patterns of care within a "real world" setting (i.e., absent clinical research protocol requirements).