The Rise of Biologics in Psoriasis Care
Psoriasis is a chronic autoimmune condition characterized by the rapid buildup of skin cells, leading to scaling, inflammation, and discomfort. For individuals with moderate-to-severe plaque psoriasis, traditional topical treatments are often not enough. In recent decades, biologic drugs have revolutionized treatment by targeting specific components of the immune system that fuel the disease [1.3.1].
These medications are complex proteins derived from living cells and are administered via injection or intravenous (IV) infusion [1.9.3, 1.11.1]. They work by blocking the action of specific cytokines—proteins like Tumor Necrosis Factor-alpha (TNF-alpha), Interleukin-17 (IL-17), or Interleukin-23 (IL-23)—that are responsible for the inflammatory cascade in psoriasis [1.11.2]. While highly effective, this advanced approach to treatment comes with a significant price tag.
What is the Most Expensive Shot for Psoriasis?
Identifying a single "most expensive" shot can be complex, as prices fluctuate and the net cost to the health system differs from the list price. However, based on net annual treatment costs, Skyrizi (risankizumab) is frequently cited as one of the most expensive biologics for psoriasis, with an annual list price that can exceed $79,000 [1.3.4, 1.2.3]. One source from June 2025 notes an annual price tag of around $120,000 without insurance [1.6.1].
It's crucial to distinguish between the list price (Wholesale Acquisition Cost or WAC) and the actual out-of-pocket cost for a patient. The list price does not account for insurance coverage, rebates, or financial assistance programs, which can dramatically lower what a patient pays [1.9.4]. For instance, a patient with commercial insurance and a manufacturer's savings card for Skyrizi may pay as little as $5 per dose [1.6.5].
Comparison of High-Cost Psoriasis Biologics
Several advanced biologics are in the high-cost category. They differ in their molecular targets, dosing schedules, and list prices. Below is a comparison of some of the leading expensive injectable treatments for psoriasis.
| Drug Name (Brand) | Target | Typical Dosing Schedule | Est. Annual List Price (First Year) |
|---|---|---|---|
| Skyrizi (risankizumab-rzaa) | IL-23 | At weeks 0, 4, then every 12 weeks [1.5.1] | ~$79,000 - $120,000+ [1.3.4, 1.6.1] |
| Bimzelx (bimekizumab-bkzx) | IL-17A & IL-17F [1.11.2] | Every 4 weeks for 16 weeks, then every 8 weeks [1.4.5] | ~$27,000 - $45,000+ [1.4.5, 1.5.1] |
| Cosentyx (secukinumab) | IL-17A | Weekly for 5 weeks, then every 4 weeks [1.7.1, 1.7.3] | ~$28,500 - $97,000+ [1.5.1, 1.7.1] |
| Ilumya (tildrakizumab-asmn) | IL-23 | At weeks 0, 4, then every 12 weeks [1.5.1] | ~$25,000 - $29,000+ [1.5.2, 1.5.1] |
| Taltz (ixekizumab) | IL-17A | Every 2 weeks for 12 weeks, then every 4 weeks [1.8.3] | ~$27,000 - $30,000+ [1.8.3, 1.4.5] |
Note: Prices are estimates based on available data and can vary significantly based on source, year, and calculation method (WAC vs. net). The actual cost to patients is typically much lower.
Why Are These Medications So Expensive?
The high cost of biologic drugs is driven by several key factors:
- Research and Development (R&D): It takes years of intensive research and hundreds of millions, if not billions, of dollars to develop, test, and bring a single biologic drug to market [1.9.3].
- Complex Manufacturing: Unlike chemically synthesized small-molecule drugs, biologics are produced by living cellular systems. This process is complex, requires strict quality control, and is expensive to scale and maintain [1.9.3].
- Patents and Market Exclusivity: Manufacturers hold patents that grant them market exclusivity for many years. This lack of direct competition allows them to set high prices to recoup their R&D investment.
- High Demand and Efficacy: These drugs have demonstrated high levels of skin clearance (PASI 90 or 100) for many patients, creating strong demand from both patients and doctors [1.3.4].
Navigating the Cost: Financial Assistance and Biosimilars
Despite the daunting list prices, several avenues exist to make these treatments affordable.
- Insurance Coverage: Most commercial insurance plans, as well as Medicare, cover biologics for psoriasis, though they often require prior authorization to ensure the medication is medically necessary [1.6.1].
- Manufacturer Copay Programs: Nearly all manufacturers offer savings cards for commercially insured patients. These programs can reduce out-of-pocket copay costs to as low as $0 or $5 per dose, up to an annual maximum benefit [1.6.5, 1.5.4].
- Patient Assistance Programs (PAPs): For uninsured or underinsured patients, manufacturers and independent non-profits run PAPs that may provide the medication for free or at a very low cost to those who meet specific income requirements [1.10.1, 1.10.3]. The National Psoriasis Foundation provides a resource center to help patients find these programs [1.10.1].
- Biosimilars: As patents for older biologics like Humira (adalimumab) and Remicade (infliximab) expire, the market for biosimilars is expanding [1.11.1]. A biosimilar is a highly similar, FDA-approved version of a reference biologic with no clinically meaningful differences in safety or effectiveness [1.11.1]. Increased competition from biosimilars is expected to drive down the overall cost of biologic therapy over time [1.3.2].
Conclusion
While newer biologics like Skyrizi command the highest list prices for psoriasis treatment, these figures don't reflect the final cost for most patients. The decision on which biologic to use is complex, involving a discussion between a patient and their doctor about efficacy, safety, and individual health factors. For patients facing high costs, a combination of insurance, manufacturer savings programs, and PAPs provides a critical financial safety net, ensuring that these life-changing medications remain accessible.
For more information on financial assistance, visit the National Psoriasis Foundation's Financial Assistance Resource Center. [1.10.1]
