New research is shedding light on stark increases in healthcare resource utilization and costs among individuals with atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD) who have systemic inflammation (SI).1
The analysis of Danish national health registers revealed patients with SI had significantly greater healthcare resource utilization, including 30% more inpatient and outpatient contacts, than individuals without SI. Additionally, those with SI generated 40% increased healthcare costs compared to individuals with no SI.1
A complex and bidirectional association exists between CKD and cardiovascular disease, including ASCVD, with each contributing to increases in the incidence and progression of the other. Both CKD and ASCVD are independently associated with an increased risk of major adverse cardiovascular events and mortality, with a proportion of this elevated risk potentially linked to SI.1,2
“While the recognition of SI as an independent driver of cardiovascular risk is growing, it is unclear how SI influences the cost and use of healthcare services,” Martin Bødtker Mortensen, of the department of cardiology at Aarhus University Hospital and Johns Hopkins, and colleagues wrote.1 “Such insights are important for a more comprehensive understanding of the healthcare burden associated with SI in individuals diagnosed with both ASCVD and CKD.”
To investigate the economic impact associated with SI on healthcare costs and resource utilization among individuals with concomitant ASCVD and CKD, investigators identified individuals among the total population in Denmark with ASCVD and CKD through the Danish National Patient Register based on ICD-10 codes and Nordic Classification of Surgical Procedures codes. Individuals diagnosed between January 1994 and December 2022 were identified, and those with ≥ 2 CRP tests observed < 6 months apart were included in the study. SI was defined as CRP from 2 mg/L-20 mg/L.1
A cohort of 522,095 individuals diagnosed with ASCVD between 1994 and 2022 was identified. Within this group, 219,523 individuals had CKD stages 3–4 following 2011, identified via the Register of Laboratory Results for Research based on eGFR 15–59 mL/min/1.73 m2. After applying exclusion criteria based on comorbid conditions, the cohort was narrowed down to 84,734 individuals who had both ASCVD and CKD. Further refinement, which included ensuring an adequate number of CRP tests and excluding individuals from or before the initial year of reporting in the RLRR, resulted in a final study population of 19,159 individuals.1
Among the cohort, 13,036 (68%) individuals met the criteria for SI. Investigators noted these patients had significantly more frequent outpatient contacts than did individuals with no SI, from 5 years before the index date until 3 years after the index date. During this period, the average person in the SI population had 6.7 more outpatient contacts than the no-SI population, with 2.3 of these excess contacts occurring after the index date.1
Similarly, investigators pointed out individuals with SI had significantly more inpatient hospital contacts than those with no SI from 4 years before the index date to 5 years after the index date. During this period, the average individual in the SI population had 7.0 more inpatient contacts compared to those with no SI; 4.7 of these excess contacts occurred after the index date.1
In the year following the index date, individuals with SI on average had 1.3 times the number of inpatient contacts, and 1.3 times the number of outpatient contacts, compared to those with no SI.1
Those with SI also had significantly greater total cost of care from 5 years before the index date to 3 years after the index date. In the first 3 years following the index event, individuals with SI generated healthcare costs EUR 14,370 (16,731.48 USD; or 1.4 times) greater than individuals without SI, with the largest difference observed in the year following the index date, when the attributable cost of SI was EUR 8525 (9925.95 USD), or 1.5 times the cost for those with no SI.1
Of note, hospital inpatient care was the primary source for the difference in costs between the 2 groups, accounting for about 85% of the total attributable cost of care during the study period.1
“In patients diagnosed with ASCVD and CKD, SI is associated with a markedly higher cost of care and more frequent contacts with the healthcare system,” investigators concluded.1 “Future research should explore whether treating SI could potentially reduce healthcare costs and utilization over time.”
References
Rudolfsen JH, Vukmirica J, Johansen P, Røder, et al. Impact of systemic inflammation on healthcare resource utilization and cost in patients with atherosclerotic cardiovascular disease and chronic kidney disease. Journal of Medical Economics. https://doi.org/10.1080/13696998.2025.2542024
Namvar T, Cavender MA, Miller E, et al. Perspectives in Managing Kidney Disease and Atherosclerotic Cardiovascular Disease. Cardiorenal Med. doi:10.1159/000539804
Breast cancer is the second most common cancer among women and the second leading cause of cancer-related deaths among women in the US.1
Nevertheless, the National Institute of Cancer (NCI) is committed to advancing breast cancer research to improve prevention, detection, and treatment as The American Journal of Managed Care® (AJMC®) highlights these efforts in recognition of Breast Cancer Research Awareness Day on August 18.2 Now, while there is a plethora of research dating back decades, more recently, there are a couple of significant advancements related to breast cancer screenings, therapies and treatment, NCI-supported research programs and clinical trials, and discoveries about breast cancer itself, many of which have potential for major impacts in breast cancer treatment and positive patient outcomes.
Research in Breast Cancer Screening
First, let’s dive into breast cancer screenings and prevention. Mammography is the primary screening tool for effective breast cancer screening for individuals with average risk. Magnetic resonance imaging, or MRIs, and ultrasound can also be used but are less frequently used for women with above-average risk.2
Mammograms are an X-ray tool that can detect lesions, calcifications, and other abnormal masses or changes in breast tissue. Over the last 50 years, there have been significant innovations to mammographs, but the most recent innovation is the implementation of artificial intelligence, or AI, which can be associated with improved early detection.² With over 2 million new cases reported in 2020, the need for more effective early diagnosis advancements is crucial for reducing the mortality rate, enhancing treatment effectiveness, and improving patient outcomes.
SimonMed, one of the largest outpatient medical imaging providers in the US, introduced its new AI-enhanced mammogram service, Mammogram+. SimonMed partnered with iCAD, a company responsible for Profound AI, which is an AI-powered mammography detection software. iCAD reported that with their software’s overall diagnostic accuracy in hard-to-find cancers improved by 22% and showed an 18% improvement in reducing false positives when reading 2D and 3D mammographs and digital breast tomosynthesis screenings.
And this is not the only instance in which AI has been used to enhance mammographs. Digital breast tomosynthesis, or DBT—which is used to obtain multiple projections to produce a 3-dimensional and sectional image of the breast—helps overcome obstructions like tissue overlap, or, more specifically, dense breast tissue that can make detecting some breast lesions more difficult. 3 DBT utilizes full-field digital mammography, which is common amongst most practices. However, DBT, unlike full-field digital mammographs, or FFDs, uses a series of low-dose 2D x-ray images from multiple different angles around the breast, which are then computed to produce a 3D volumetric image of the breast.4
The digital reconstruction significantly improves visualization of lesion edges and reduces diagnostic errors, thus lowering the occurrence of false negatives. A recent study published in the National Library of Medicine has introduced AI deep learning technology with DBT to help improve digital reconstruction and analysis. AI deep learning, when used with DBT and radiologists, has led to substantial increases in patient survival due to improved speed and accuracy in detecting and diagnosing lesions.4
On the other hand, while researchers have seen success using deep learning with DBT, there are still a few hurdles to overcome. One of the main challenges of applying deep learning and other AI models to DBT is the interpretability and lack of transparency in decision-making, which in turn makes it harder for doctors to detect and correct interpretive errors, resulting in misdiagnoses like false negatives.However, that’s not the end-all be-all. Currently, strategies to improve the interpretability of deep learning models by introducing things like innovative neural network architectures and visualization techniques that can help doctors to better understand the decision-making process of the AI model, in addition to a multiview feature fusion, which combines information from multiple angles and image types, help create a complete and more reliable image to further help doctors come to a concrete conclusion.4
Nevertheless, enhanced mammograms have the potential to advance early detection. The 5-year survival rate of patients with stage I breast cancer is 100% when compared with patients with stage IV disease, whose survival rate then drops to 25%.4 These data just go to show how crucial early detection and diagnosis are in improving outcomes and overall survival.
Research Addressing Breast Cancer Disparities
Although breast cancer is the second leading cause of cancer-related deaths among women in the US, Black women have a 40% higher mortality rate from breast cancer than White women as of 2024, according to the HHS Office of Minority Health. 5 Recent studies attribute high misdiagnosis rates and even higher prevalence of aggressive cancers to disproportionate access to screenings—which in turn delays diagnosis—and genetic differences that predispose Black and African American women to more aggressive cancers like triple-negative breast cancer.6-8
While we’re still relatively fresh off the topic of breast cancer screenings, in recent news, Pennsylvania passed a law eliminating costs for supplemental screenings for women with an established risk of breast cancer, genetic predispositions, or heterogeneously dense breast tissue, among other criteria. However, if we narrow in on women with dense breast tissue—which Black women are more likely to have—they still were ineligible to receive supplemental screenings under this law based on the breast density and breast cancer risk standardized guidelines.7 Women with dense breast tissue have a risk of breast cancer 5 times that of women with non-dense breast tissue, and they also have higher rates of false-negative mammograms.
Now, under this law, the measurement tools used were the Breast Imaging and Reporting Data System, or BI-RADS, which set the parameters for breast tissue density, and the Breast Cancer Risk Assessment, or BCRAT, which calculates lifetime risk of breast cancer. A recent clinical trial measuring outcomes for supplemental screenings by race, under this Pennsylvania law, reported fewer cases of extremely dense breast tissue in Black women when compared with White women and even fewer with a BCRAT greater than 20%. Now, under this state-level legislation, a woman must have either heterogeneously dense or extremely dense breast tissue and a BCRAT score greater than 20%. However, with these stipulations, Black women had a sensitivity of 0%, meaning there were 0 false-negative mammograms in Black women that were correctly identified as eligible for supplemental screenings out of the 39,397 Black women in this study. However, when researchers adjusted for women missing BCRAT scores, Black women’s sensitivity rose to 53%.7
Another stipulation of the law recognized genetic risk, and while it was not investigated in the clinical trial, there are other studies that have. I briefly mentioned before that Black women are prone to more aggressive breast cancers like triple-negative breast cancer or inflammatory breast cancer.6 A recent study in NPJ Breast Cancer observed improved survival outcomes in Black women with triple-negative breast cancer and increased levels of regulatory T cells and overall T cell populations. These findings encouraged researchers to suggest more specific studies as to why Black women have a higher abundance of certain immune cell populations and how this can be used to advance breast cancer therapies.
Now if we zoom in a little further beyond the cell and look at our DNA, another study published in Nature Genetics found genetic variants at 12 loci associated with breast cancer risk, and among the 18,034 cases evaluated in this genome-wide association study, researchers found that 15.4% of cases with triple-negative breast cancer carried 6 out of the 12 risk alleles.7
All in all, while there is ongoing research to identify differences in breast cancer in Black women compared with other races and ethnicities, there is still more to be learned about genetic differences impacting how breast cancer presents in women by race and ethnicity and adjusting policies to account for these differences.
Research in Breast Cancer Treatment
There is a plethora of treatments for breast cancer, including surgery, radiation, hormone therapy, chemotherapy, targeted therapy, and immunotherapy. More recently, researchers from Hebrew University made an advance in targeted therapy for breast cancer and developed a new “drug-like” molecule with the ability to degrade the RNA-binding protein, Hu antigen R, or HuR, which plays a crucial role in preserving oncogene cell proliferation, survival, and metastasis, critical processes that all promote oncogenic mRNA stabilization. The molecule MG-HuR2 reduced HuR levels by up to 80%, disrupting expression of downstream oncogenes and significantly inhibiting cell proliferation, survival, and 3D tumor spheroid growth. The study authors believe this discovery will pave the way for future studies aimed at RNA-binding protein degradation in cancers.9
Now, while this degrader has not yet made it to clinical trials, as the study was just published in early July of 2025, in 2023, however, the FDA approved an oral hormonal therapy, a selective estrogen receptor degrader, or a SERD, which is more effective than other hormone therapies in postmenopausal women and men with various subtype of breast cancer. These include estrogen receptor positive, or ER+, human epithelial growth receptor 2 negative, or HER2-negative, estrogen receptor alpha-1, or ESR1, mutated advanced or metastatic breast cancer. The brand name of the drug is Orserdu, produced by Stemline Therapeutics, Inc., and in the clinical trials, participants with the ESR1 mutation saw zero progression of their cancer for a little less than 4 months while receiving treatment when compared with patients on another hormone therapy, fulvestrant, an injectable SERD, who only saw their cancer progression stall for 2 months while receiving treatment.10
Another oral SERD, imlunestrant, was also shown to be more effective than traditional hormone therapies at slowing the growth of ESR1-mutant tumors in women with advanced ER-positive, HER2-negative breast cancer. And when combined with the cell growth blocker abemaciclib, the SERD was better in treating those with mutated and unmutated ESR1 tumors.11
In regard to immunotherapy, which helps the body’s immune system fight the cancer more efficiently and effectively, there have also been recent advancements in immunotherapy drugs, or immune checkpoint inhibitors. Evidence has shown that these inhibitors may improve how long someone with advanced breast cancer can live. This type of treatment is more common for individuals with advanced or more aggressive subtypes of breast cancer.10
The reported findings of a clinical trial on the outcomes of the immunotherapy drug pembrolizumab, published earlier this year in the National Library of Medicine, showed improved outcomes in patients with early-stage triple-negative breast cancer who were treated before and after surgery, leading to FDA approval. 10, 12
The progressive nature of hormone, targeted, and immune therapies alludes to promising advancements in breast cancer treatments that have the potential to improve outcomes amongst patients with various subtypes of breast cancer.
The NCI is also conducting clinical trials that assess and evaluate breast cancer screening, treatment, and prevention from multiple angles, with the goal of advancing knowledge and improving patient outcomes.
References
1. Breast cancer statistics. Centers for Disease Control and Prevention. June 10, 2025. Accessed July 31, 2025. https://www.cdc.gov/breast-cancer/statistics/index.html
2. Advances in breast cancer research. NCI. April 8, 2025. Accessed July 31, 2025. https://www.cancer.gov/types/breast/research#research-in-breast-cancer-treatment
3. Nicosia L, Gnocchi G, Gorini I, Venturini M, Fontana F, Pesapane F, et al., History of mammography: analysis of breast imaging diagnostic achievements over the last century. Healthcare (Basel). 2023;11(11):1596. doi:10.3390/healthcare11111596
4. Wang R, Chen F, Chen H, Lin C, Shuai J, Wu Y, et.al., Deep learning in digital breast tomosynthesis: current status, challenges, and future trends. MedComm (2020). 2025;6(6):e70247. doi:10.1002/mco2.70247
5. Cancer and Black/African Americans. Office of Minority Health. February 13, 2025. Accessed August 6, 2025. https://minorityhealth.hhs.gov/cancer-and-blackafrican-americans#footnote1
6. Omilian AR, Mendicino L, George A, et al., Quantitative analysis of T cell subsets in a population of Black women with invasive breast cancer. NPJ Breast Cancer.2025;11(1):64.doi:10.1038/s41523-025-00780-5
7. Mahmoud MA, Ehsan S, Ginzberg SP, Domchek SM, Nathanson KL, Conant EF, et.al., Racial differences in screening eligibility by breast density after state-level insurance expansion. JAMA Netw. Open. 2025;8(8):e2525216. doi:10.1001/jamanetworkopen.2025.25216
8. Jia, G, Ping, J, Guo, X, et al., Genome-wide association analyses of breast cancer in women of African ancestry identify new susceptibility loci and improve risk prediction. Nat Genet. 2020;56:819-826. doi:10.1038/s41588-024-01736-4
9. Kassabri L, Benhamou RI. Druglike molecular degraders of the oncogenic RNA-binding protein HuR. JACS Au. Published online July 16, 2025. doi:10.1021/jacsau.5c00551
10. Center for Drug Evaluation and Research. FDA approves elacestrant for ER-positive. U.S. Food and Drug Administration. Accessed August 8, 2025. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-elacestrant-er-positive-her2-negative-esr1-mutated-advanced-or-metastatic-breast-cancer
11. Jhaveri KL, Neven P, Casalnuovo ML, Kim SB, Tokunaga E, Aftimos P, EMBER-3 Study Group. Imlunestrant with or without Abemaciclib in advanced breast cancer. N Engl J Med. 2025;392(12):1189-1202. doi:10.1056/NEJMoa2410858
12. Cardoso F, O’Shaughnessy J, Liu Z, McArthur H, Schmid P, Cortes J, Pembrolizumab and chemotherapy in high-risk, early-stage, ER+/HER2- breast cancer: a randomized phase 3 trial. Nat Med. 2025;31(2):442-448. doi:10.1038/s41591-024-03415-7
The Spain midfielder said “there is nothing better than when your opponents recognise your job” after picking up her first PFA award.
Caldentey told BBC Sport: “As a footballer, you want to win the trophies with the team and then when you are successful, this happens.
“It feels nice but I want to win trophies with the club.”
Arsenal team-mate Alessia Russo, Manchester City pair Mary Fowler and Yui Hasegawa, Chelsea’s Erin Cuthbert and Manchester United’s Phallon Tullis-Joyce were also on the shortlist.
Spain international Caldentey was named the WSL player of the year in May, an award that was voted for by supporters.
Arsenal finished second in the WSL, behind champions Chelsea, but beat Barcelona 1-0 in the Champions League final with Caldentey playing the whole match.
Canada forward Smith said it “means the world to her” to become the first foreign player to win the award.
She told BBC Sport: “This genuinely means the world to me, knowing that no other foreigner has won this award.
“Whenever I go home it’s so cool to see the girls that are inspired by me, and being a role model they look up to is massive for me and a huge privilege. I want this to help other girls and boys.”
Smith, 21, became the most expensive signing in women’s football history when she completed a £1m move to the Gunners from Liverpool in July.
Smith made her international debut at 15 and joined Liverpool from Portuguese side Sporting a year ago for a club-record fee of just over £200,000.
She scored nine goals in 20 matches in the WSL before agreeing a move to Arsenal in July.
Also in the running for the PFA young player of the year award were Chelsea trio Aggie Beever-Jones, Maika Hamano and Weikie Kaptein; Manchester United midfielder Grace Clinton, who won the accolade in 2024; and Manchester City’s Fowler.
EXCLUSIVE: Zack Snyder’s long-awaited passion project, The Last Photograph, is ready for its closeup. The Rebel Moon director has set the drama as his next film and cast Stuart Martin and Fra Fee to star. Snyder worked with both actors on his recent sci-fi franchise Rebel Moon and, after recently securing financing to get the film off the ground, set the two rising stars to headline the film.
The film begins production this month and will shoot through November in Iceland, Colombia and Los Angeles .Snyder will direct the film from a screenplay by Kurt Johnstad, with Snyder having a story-by credit. Zack Snyder, Deborah Snyder and Wesley Coller will produce through Stone Quarry and continue their creative partnership with Gianni Nunnari who is producing through Hollywood Gang Productions along with co-producer Alisha Stickney.
Executive producers include Mediaset España, through its film production arm Telecinco Cinema, William Doyle and Jaguar Bite. True North serves as the production service company in Iceland, while Jaguar Bite, run by Juan Pablo Solano and Simon Beltran, serves as the Colombian production service company. Hans Zimmer, Steven Doar and Omer Benyamin are handling the score.
“The idea of taking camera in hand and simply making a movie in an intimate way is very appealing to me,” said Snyder. “The Last Photograph is a meditation of life and death, embodying some of the trials that I have experienced in my own life and the exploration of those ideas through image making.”
The project has received approval to obtain the CINA incentive (Audiovisual Investment Certificate), granted by the Colombian government and administered by Proimágenes Colombia: a tax discount equivalent to 35% of the expenditure on audiovisual services in the country.
The story follows an ex-DEA operative who must return to the mountains of South America in an effort to find his missing niece and nephew, following the brutal murders of their diplomat parents. Enlisting the help of a washed-up junkie war photographer, the only person to have seen the face of the killers, he sets out, determined to find the children and the truth, but soon learns he must also face the ghosts of his past. Their journey into the unknown takes them farther and farther away from civilization, bringing into question everything they believe, while slowly eroding the distinction between real and surreal.
Snyder has long wanted to make The Last Photograph, but his busy schedule directing big-budget tentpoles has always led to having table the film. Recently, he not only saw a window to fit the film in before focusing on another large production and also had the actors he wanted to star in it after the three had a strong bond working on Rebel Moon together. Once the financing was in place, pre-production was off to the races, and Snyder officially was underway. He is repped by CAA and Sloane Offer Weber & Dern.
Martin’s star has been on the rise for some time with not only key roles in Snyder’s two Rebel Moon pics but the Snyder-produced heist thriller Army of Thieves. On the TV side, Martin has the Channel 4 series In Flight. He is repped by UTA, Independent Talent Group, Untitled Entertainment and Sloane Offer Weber Dern.
Besides the Rebel Moon films, Fee most recently was seen in the Apple TV+ series Prime Target and also had a role in the Marvel series Hawkeye. He is repped by Paradigm Talent Agency, 42, Untitled Entertainment and Goodman Genow Schenkman.
Gold declined as traders weighed US-led efforts to end the war in Ukraine and counted down to the Federal Reserve’s annual Jackson Hole gathering, which may yield hints on possible interest-rate cuts.
Fed Chair Jerome Powell is scheduled to deliver a keynote address at the central bankers’ meeting on Friday, and his remarks may reinforce investors’ widespread expectations for looser monetary policy. Lower borrowing costs typically benefit the precious metal, a non-yielding asset.
(NEXSTAR) – Just a few weeks after twin meteor showers passed overhead, there’s another astronomical phenomenon set to occur – a “Black Moon.”
Rising Aug. 23, the Black Moon won’t be as eye-catching as other celestial events this month – in fact you won’t be able to see the moon at all – but its rarity makes it fascinating, according to Space.com. While not an official astronomical term, Black Moon is used to describe “unusual timings of new moon phases.”
To understand it better, it may help to think about the Blue Moon, of “Once in a Blue Moon” fame. The phrase references the rare “extra” full moon that happens every two-and-a-half years, according to NASA.
Because the moon’s cycle is 29.5 days, slightly less than the average month, eventually a full moon will fall on the first or second day of the month, allowing for another full moon to occur just before the month ends.
Conversely, a Black Moon refers to the new moon phase, or as NASA puts it “the invisible phase” when the moon rises with the sun, but is positioned between Earth and the sun. The illuminated side of the moon is opposite Earth, making it impossible to see.
A Black Moon also happens due to the gap between the lunar cycle and the average length of the calendar month, with the term being used for the third of four new moons in a season, according to Weather Network meteorologist Scott Sutherland. August 23 marks the third new moon of the 2025 summer season, with the fourth falling on Sept. 21, according to Space.com.
Alternatively, a Black Moon can also mean the second new moon in a single calendar month, a phenomenon that won’t happen again until Aug. 31, 2027.
For anyone still underwhelmed by the upcoming Black Moon, keep in mind that a new moon also brings the darkest night sky and best chance to star gaze.
Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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Psoriasis affects more than 8 million individuals in the US, presenting not only as a cosmetic problem but also playing a profound role on quality of life.1 Advances in systemic therapies, particularly biologics, have substantially improved outcomes for patients with moderate-to-severe disease. Yet access to these transformative treatments remains uneven.2 Beyond clinical efficacy, effective psoriasis management requires attention to the emotional and social impacts of the disease. Research has shown that higher levels of disease acceptance correlate with better quality of life and reduced symptom severity, highlighting the need for patient-centered, interdisciplinary approaches that integrate psychological support with dermatologic care.3 For managed care organizations, these insights underscore the importance of benefit designs and care models that not only facilitate access to advanced therapies but also support holistic, patient-focused strategies that improve adherence, outcomes, and overall well-being.
National Psoriasis Awareness Month offers an opportunity to examine how advances in systemic therapy, combined with patient-centered care models, are reshaping the treatment landscape. | Image credit: Sviatlana – stock.adobe.com
How Psoriasis Treatment Has Evolved
Recent advances in systemic therapy for psoriasis have expanded treatment options beyond traditional biologics, with a growing focus on small-molecule oral and topical drugs that target key immune pathways.4 With the expanding array of systemic therapies, dermatologists are increasingly adopting a patient-centered approach to selecting treatment.
Steven Daveluy, MD, board-certified dermatologist, Wayne State University, highlighted how the evolution of systemic therapies has transformed psoriasis care, making treatment far easier and more effective than in the past. Historically, patients with severe disease faced limited options such as phototherapy, tar applications, methotrexate, or cyclosporine—treatments that were often difficult to manage, less effective, and carried significant risks. Today, dermatologists have access to a wide range of highly effective medications with favorable safety profiles, allowing for more reliable long-term disease control with fewer side effects.
“Now that we have so many highly effective medications that have such great safety profiles, it really is pretty easy to treat even the most severe psoriasis,” said Daveluy, in an interview with The American Journal of Managed Care® (AJMC®).
“My approach is completely patient-centric, so I don’t use the same treatment ladder for each patient,” Lauren Eckert Ploch, MD, MEd, FAAD, dermatologist, told AJMC in a written interview. “I discuss the options with my patients to gauge their desire for a systemic vs. topical treatment, and we base our shared decision on how severe their psoriasis and psoriatic arthritis are.”
Clinical decision-making also considers individual risk factors and comorbidities that need to be weighed when tailoring treatment plans for individual patients.
“I look at malignancy history, joint involvement, and extent of skin disease,” explained Ploch. “I also look at other comorbidities (ie, hypertriglyceridemia, heart disease, kidney disease, etc.) and decide from there.”
Improving Patient Access and Education
Despite the substantial improvements in outcomes afforded by biologic therapies, not all patients with psoriasis have equitable access to these treatments. A systematic review of US studies found that disparities in biologics access are influenced by insurance type, race or ethnicity, high out-of-pocket costs, and prior authorization requirements—barriers linked to higher hospital admissions, readmissions, emergency department visits, and treatment delays.2 Beyond these structural challenges, social determinants of health can profoundly affect dermatologic outcomes. During a recent Society for Pediatric Dermatology session, Sarah Coates, MD, FAAD, highlighted how financial hardship, low health literacy, limited access to care, and adverse childhood experiences can worsen conditions such as psoriasis.4
“The biggest hurdle is cost,” emphasized Ploch. “While there are several new topicals on the market, they’re completely unaffordable and not often covered by plans like Medicare. Extensive areas are best treated with systemic therapy. It’s really difficult to treat full-body psoriasis with a 60 g tube of cream. Insurance coverage is the issue. Some insurances will deny the most appropriate treatment in favor of something else. Sometimes the one they favor is not safe for the patient in question.”
Daveluy echoed this sentiment, emphasizing that one of the biggest barriers to maintaining patients on systemic therapies is not clinical efficacy but logistical challenges such as insurance changes, lapses in coverage, and pharmacy delays. To address these disruptions, his practice works proactively to educate patients about the potential for formulary changes and the need to alert the office immediately if insurance instability occurs. In some cases, medication samples are provided to bridge gaps in coverage, helping patients avoid treatment interruptions. The care team also assists patients in navigating insurance and pharmacy hurdles, though these processes can still be time-consuming and frustrating. By setting expectations early and encouraging open communication, Daveluy noted, patients are better prepared to handle disruptions and more likely to remain engaged with their care, ultimately supporting adherence and continuity of treatment.
“I try to inform patients if they have any sort of insurance instability where maybe they lose it for a while to let us know, because we can often give them samples of the medications to get them through so they don’t have to go without and then flare up,” said Daveluy.
Overall, the evolution of psoriasis care demonstrates the powerful intersection of clinical innovation, patient-centered practice, and health system design. With the availability of highly effective systemic therapies, dermatologists are now able to achieve outcomes that were once unimaginable, offering patients long-term disease control with fewer side effects. Yet these advances cannot fully deliver on their promise without addressing the persistent access barriers rooted in insurance design, cost, and social determinants of health.
By aligning coverage with patient needs and supporting interdisciplinary, holistic approaches, payers and providers together can help more individuals with psoriasis achieve meaningful, sustained improvements in both health and quality of life.
References
1. Psoriasis statistics. National Psoriasis Foundation. Updated December 12, 2021. Accessed August 19, 2025. https://www.psoriasis.org/psoriasis-statistics/
2. Wright GC, Okoye GA, Ehrlich AC, et al. US health care disparities in immunology biologics access: a systematic review. Am J Manag Care. 2025;31(8):414-420
3. Steinzor P. How psoriasis acceptance impacts severity, itch, and quality of life. AJMC. January 10, 2025. Accessed August 14, 2025. https://www.ajmc.com/view/how-psoriasis-acceptance-impacts-severity-itch-and-quality-of-life
4. Steinzor P. SPD 2025: Research highlights, personalized treatment, and barriers to care. AJMC. August 4, 2025. Accessed August 14, 2025. https://www.ajmc.com/view/spd-2025-research-highlights-personalized-treatment-and-barriers-to-care
When USAFacts recently published updated measles case data, we received an outpouring of public interest—and one repeated question: Why can’t we see the number of measles cases in every state and county?
Measles was declared eliminated in the United States in 2000, and with that milestone came an unintended consequence— tracking and presenting this information publicly in a centralized yet local view has not been a priority of our public health system. While this made sense when cases waned, today, as cases surge, we are left with a patchwork of reporting standards, delayed updates, and blind spots.
This is not the first time Americans have found themselves questioning what is happening locally during public health crises. At the onset of COVID-19, the Centers for Disease Control did not have an effective way to collect and present case data from states. Instead, for the first several months of the pandemic, they relied on the data we collected and visualizations we produced at USAFacts to fill in gaps and help Americans understand what was happening in their communities. This data was of extreme national interest—traffic to our website grew from 1.5 million visitors a year to 28 million with the COVID-19 pages bringing in the vast majority of our visitors. The demand was clear: people don’t just want health data—they need it, especially when it is local.
We are now in a similar moment. The high-level overview of measles cases available from the CDC is insufficient for the American citizen who might be fearful from reading the news and wants to see what is happening where they live. For a dangerous disease like measles—particularly to young children and immunocompromised individuals—this should concern everyone from parents to policymakers to public health officials.
We know how to do better. During the pandemic, states learned how to mobilize and collect, clean, and share health data with the public. At first, without national standards, they were inconsistent in how they reported, what they presented to the public, and how frequently they updated. Eventually, every state and the CDC produced robust tracking dashboards, but those systems weren’t built to last. As the emergency waned, so too did the urgency for thorough, transparent data reporting.
We understand the difficulty—collecting national data is hard when we have over 90,000 state and local governments in the United States. But COVID taught us the lesson of how important it is that critical data can be quickly collected, standardized, and presented—a lesson we seemed to quickly forget as evidenced by our current measles tracking resources. The federal government, and in this case the CDC, should present this data to the public and create standards for state reporting to help them in this endeavor.
The measles surge is not just a wake-up call —it’s a reminder about the fragility of our health data systems. Knowing where and how an infectious disease is spreading is necessary to respond effectively. And the public deserves to easily know what risks exist in their own communities.
Richard Coffin is Chief of Research and Advocacy at USAFacts, Steve Ballmer’s not-for-profit, nonpartisan civic initiative aimed at empowering Americans with facts by making government data more accessible, understandable, and useable. He joined the organization as its first employee in 2015 and guided it through its initial research and ideation phase, oversaw its launch, and steered its product vision as the organization expanded and evolved. In his role leading research and advocacy, Richard and his team oversee the organization’s research efforts including its publications, standards of analysis, and subject matter expertise.
