OBJECTIVES: Assess the timing of biologic initiation and associated healthcare utilization and costs among psoriasis (PsO) patients. METHODS: Adults (18-64 years) with ≥2 PsO diagnoses (ICD-9-CM=696.1) after 4/30/2004, ≥1 non-biologic pharmacologic systemic treatment (“non-biologic”) after the first observed diagnosis, and ≥1 biologic treatment after the first non-biologic were selected from a de-identified US-based claims database. The index date was the date of the first biologic after the first non-biologic prescription fill. Patients had continuous eligibility during the 12-months before (baseline) and 24-months following (study period) the index date. Patients were categorized into two cohorts based on days from the first non-biologic to index date: “>180-days” and “≤180-days”. Study period utilization and costs were compared between cohorts using unadjusted and multivariable adjusted analyses. RESULTS: There were 759 “>180-days” and 881 “≤180-days” patients identified. During baseline, more patients in the“≤180-days” cohort had psoriatic arthritis compared to the “>180-days” cohort (38.3% vs. 31.1%). “≤180-days” patients incurred more inpatients visits; higher medical, inpatient, and outpatient costs; and lower pharmacy costs compared to “>180-days” patients during baseline. During the study period, the “≤180-days” cohort had higher unadjusted number of emergency room (0.52 vs 0.45) and outpatient visits (36.03 vs 31.89) as well as higher total ($20,971 vs $17,922, excluding PsO biologic costs), medical ($15,577 vs $12,749), and outpatient costs ($11,466 vs $9,527) (all p-values<0.05). Multivariable regressions adjusting for baseline characteristics confirmed the unadjusted results. The numeric difference in adjusted costs between cohorts was small (adjusted 24-month difference in total, medical, and pharmacy costs=$3,123, $1,851 and $2,464, p-value=0.0609, 0.0016, and 0.2202, respectively). CONCLUSIONS: PsO patients initiating biologics ≤180-days from the first non-biologic had more severe disease and higher costs at baseline. Over the 24-month study period, differences in healthcare utilization and costs between patients with different timing of biologic initiation were small and not clinically meaningful.