Patient Says He Offered Thousands Out of Pocket for a Psoriasis Biologic

A psoriasis patient was ready to pay thousands of dollars out of his own pocket for risankizumab — until his dermatologist redirected him to a biologic that Medicare Part B would cover. That single moment, described in the closing installment of a Dermatology Times Case-Based Peer Perspectives series on plaque psoriasis, shows how decisively cost and coverage, not efficacy alone, shaped one man's treatment course.

The patient is Keki Mody. His physician is Dr. Jeffrey Bunick. Their exchange closes a multi-part patient-perspective program on plaque psoriasis care.

What did psoriasis actually cost this patient day to day?

Mody describes a disease that hit him emotionally more than functionally. He could hide plaques on his legs, hands, and chest under ordinary clothing. Work was rarely a problem; he always wore suits. The limits showed up elsewhere. He avoided shorts. He felt self-conscious at the beach.

The heaviest burden was private. At home, Mody says, he kept wondering when the disease would finally go away — a quiet, repetitive worry that never made it into visible symptoms.

Dr. Bunick highlights how heavily cost weighed on Mody's decisions, and Mody confirms the pressure was significant. His answer, at one point, was blunt: he told Bunick he would pay thousands out of pocket for risankizumab before Bunick steered him to tildrakizumab instead.

Bunick explains the principle behind that redirect. He asks himself 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. For patients watching their coverage, the takeaway is plain: a cheaper covered drug beat an expensive one here, without any stated trade-off in outcome.

How did a second diagnosis change the choice?

Mody's case carries a comorbidity that factored directly into drug selection. He has a concurrent MGUS diagnosis — monoclonal gammopathy of undetermined significance — now characterized as smoldering myeloma.

That mattered. Mody says his rheumatologist actively supported an IL-23 inhibitor, partly because of possible benefit in slowing MGUS progression. His treatment choice therefore served two purposes at once: clearing skin and, potentially, protecting against a hematologic progression.

Monitoring has since eased. After years of stable lab results, Mody's check-ins have dropped from every three months to twice a year — a concrete measure of how stable his situation has become.

Does dosing frequency matter to patients?

On dosing, Mody's experience argues against assuming monthly injections are a burden. Monthly secukinumab never felt difficult to him, he says, because shipments arrived automatically and required no effort on his part.

Still, preference is preference. Given a choice, he would opt for every-12-week dosing over monthly injections. For clinicians weighing adherence conversations, that is the takeaway: logistics may be solved, but less frequent dosing still wins on patient preference.

What does Mody want other patients — and clinicians — to know?

He is an advocate now. Mody encourages other patients with psoriasis to pursue biologic therapy, contrasting his own outcome with friends who suffered visibly for years, unnecessarily in his view, without treatment.

His observations extend to older patients generally. He notes that other older patients, including his own wife, experience significant anxiety before medical appointments — a reminder that the emotional load of care doesn't end when the plaques clear.

Access is physical, too. Mobility-limited patients, Mody points out, can face real difficulty simply reaching a facility where a biologic is administered — an access barrier that rarely appears in efficacy data but sits squarely in real-world shared decision-making.

His account, taken whole, makes the case that cost, comorbidities, dosing logistics, and the anxieties of aging patients belong at the center of psoriasis treatment conversations, not at the margins — and as biologics multiply, expect those conversations to grow only more central.