Psoriasis is a chronic skin condition affecting 2% to 3% of the population; in severe cases, hospitalization can result if left untreated. Phototherapy with ultraviolet light is a safe and effective treatment, in which patients sit in front of a lightbox for several minutes, 2 or 3 times per week. However, receiving this simple treatment can be inconvenient for patients who live far from the clinic or have work, home, or transportation barriers, and many of those unable to receive phototherapy treatment in the clinic elect to take systemic medications with greater risk of side effects.
At the initiation of William Lide, MD (former dermatologist with The Permanente Medical Group, now with Northwest Permanente), Dr. Click and colleagues Maisha Draves, MD and Ngoc Pham, MD began advocating in 2015 for Kaiser Health Plan to cover phototherapy units for home use. Once this was approved, Katherine Clyman, MD worked with regional pharmacy to develop a program of educating patients and ordering home lightboxes for those with moderate-to-severe psoriasis.
Pilot research led by Drs. Lide and Click showed that one-quarter of patients who received a lightbox for home use no longer took systemic medications. At the same time, the physician-researchers learned that patients with high cost-shares were unlikely to obtain the equipment.
When KP dermatology clinics shut down in-office phototherapy treatments in spring 2020 due to the pandemic, Drs. Click, Clyman, Draves, and Pham leveraged the pilot lightbox program to transition Northern California psoriasis patients to home care, which also reduced the risk of more-severe COVID-19 infection in patients on immunosuppressive medications.
In July 2021, home phototherapy coverage was extended across Kaiser Permanente via an enhancement in the durable medical equipment formulary, with no copay for most members. Today more than 5,000 patients in Northern California are using home phototherapy at almost no or very little cost for the lightbox.
“These four physicians exemplify the best in Permanente medicine,” says Sameer Awsare, MD, TPMG associate executive director. “Not only did they collaborate across specialties, but they also did the right thing for our patients by giving them the safest, most convenient care which treats their condition without systemic medications that have potentially harmful side effects.”