Ilumya® for Psoriasis

Ilumya is an FDA-approved biologic medication used to treat adults with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy.

Psoriasis is an inflammatory condition in which an overactive immune response contributes to the rapid production of skin cells. This can lead to the characteristic red or discolored, thick, scaly plaques associated with the condition.

Ilumya belongs to a class of medications known as IL-23 inhibitors. It works by selectively blocking the p19 subunit of interleukin-23 (IL-23), a signaling protein involved in the inflammatory pathway that contributes to psoriasis. By targeting this pathway, Ilumya can significantly reduce psoriasis activity in many patients.

Ilumya has been studied in large clinical trials involving adults with moderate to severe plaque psoriasis. In the pivotal Phase 3 reSURFACE clinical trials, significantly more patients receiving Ilumya achieved substantial improvement in their psoriasis compared with those receiving placebo. Many patients experienced considerable improvement in the redness, thickness, scaling, and overall extent of their psoriasis.

Response varies from patient to patient, and no psoriasis treatment works equally well for everyone. Your dermatologist can help determine whether an IL-23 inhibitor such as Ilumya is appropriate based on the severity and location of your psoriasis, previous treatments, other medical conditions, and insurance coverage.

One advantage of Ilumya is its relatively infrequent dosing schedule. Treatment begins with an injection at week 0, followed by another injection 4 weeks later. After these initial doses, Ilumya is generally administered once every 12 weeks. This means that after the initial treatment period, most patients receive only four scheduled treatments per year.

Ilumya is administered by a healthcare professional, so patients do not need to give themselves injections or routinely manage the medication at home.

This is an important question for many patients considering biologic treatment for psoriasis. Because Ilumya is administered by a healthcare professional in the medical office, treatment may be covered under Medicare Part B when Medicare’s applicable coverage and medical-necessity requirements are met. This differs from many self-administered prescription medications that are typically obtained through a pharmacy and may fall under Medicare Part D. The distinction between Part B and Part D coverage can make a significant difference in how a biologic medication is covered.

Patients should not assume that Ilumya will automatically be covered, however. Coverage can depend on Medicare requirements, the patient’s diagnosis, treatment history, documentation of medical necessity, and other applicable coverage criteria.

Patients with Medicare and a Medicare Supplement (Medigap) policy may have additional coverage for some or all of the Medicare-approved cost-sharing that would otherwise be the patient’s responsibility. Other patients may have Medicare together with another form of secondary coverage, such as certain retiree health plans.

As a result, some patients with Medicare and appropriate supplemental or secondary coverage may have limited out-of-pocket costs for Ilumya treatment after both insurers have processed the claim. The exact amount varies substantially based on the individual’s insurance coverage. Having secondary insurance does not necessarily mean that treatment will have no out-of-pocket cost.

Before beginning treatment, our office can review insurance benefits and help patients better understand their anticipated coverage.

Ilumya is generally well tolerated, but like all prescription medications, it has potential risks and side effects.

Because Ilumya affects the immune system, it may increase the risk of infection. Patients should be evaluated for tuberculosis before beginning treatment and should discuss a history of recurrent infections or other significant medical conditions with their dermatologist.

Adverse reactions reported with Ilumya include upper respiratory infections, injection-site reactions, and diarrhea. Patients should also discuss vaccinations with their healthcare provider. Live vaccines should generally be avoided during treatment with Ilumya.

Ilumya may be considered for adults with moderate to severe plaque psoriasis whose disease warrants systemic treatment or phototherapy. It may be particularly appealing to patients who prefer:

• An infrequently administered biologic treatment
• Treatment administered by a healthcare professional rather than self-injection
• An IL-23 targeted treatment
• Only four maintenance treatments per year after the initial doses

For patients with Medicare and supplemental insurance, the way Ilumya is administered and billed may also be an important consideration when comparing psoriasis treatment options.

The best biologic medication is not the same for every patient. Treatment selection should consider the patient’s psoriasis, medical history, previous treatments, lifestyle, preferences, and insurance coverage.

The cost of biologic medications can understandably be a concern, and some patients may assume that newer psoriasis treatments will be unaffordable once they transition to Medicare. That is not always the case.

Because certain biologic treatments such as Ilumya are administered in a physician’s office, their Medicare coverage may differ from self-administered medications obtained through a pharmacy. For patients who also have Medigap or other secondary insurance, additional coverage may further reduce their out-of-pocket responsibility.

At Vue Dermatology & Laser, we evaluate psoriasis treatment on an individual basis. For patients considering Ilumya or another systemic psoriasis treatment, our team can review treatment options and verify available insurance benefits before therapy begins.