Equitable access to biologic therapies in a psoriasis safety-net clinic: A retrospective cohort study

Access to biologic therapies for psoriasis remains uneven among uninsured or underinsured patients, despite safety-net systems and manufacturer assistance. A retrospective cohort study examined all patients treated for psoriasis at the Psoriasis Biologics Clinic at Jackson Memorial Hospital (Miami, Florida) from January 2020 to May 2025. With no exclusions, the cohort reflected the full clinic population. The study assessed eligibility and initiation of biologics within a model combining hospital financial assistance and manufacturer support. Among 187 patients (mean age 52.7 years; 55.6% women), 67.4% were prescribed biologics. Most identified as Hispanic, with smaller African-American and non-Hispanic White groups. Adalimumab and secukinumab were the most common therapies. Insurance sources included government programs, hospital assistance, and underinsured plans. Barriers to starting biologics were reported in 15.5% of patients, mainly due to insurance denials or lapses. Nearly all patients had no copay, and those using the Jackson Financial Assistance Program received biologics at no cost. Although this safety-net model enabled most patients to access biologics, ongoing racial and insurance-related disparities indicate the need for broader structural and policy solutions to achieve durable equity in care.