The Big Skyrizi

If you’ve seen me in the past few years, you’ll know that my psoriasis has continued to get worse. I haven’t quite reached the state of Michael Gambon in The Singing Detective, but I was on my way. It was covering about 30%-40% of my body, over the back of my head, and in the last few months I had noticed that it had started on my face, one of the very few places it had left mostly untouched. We joke about my little ‘shame vacuum’, but it’s true: I have a rechargeable hoover hanging around so I can suck up flakes on my chair, the sides of the bed, the bed itself. Winter is always the worst, especially up here in the north of the US; it gets so cold and so dry that my skin turns into an even flakier mess than it is in the summer.

We tried many things! Back when I first got to the US in 2011, I had a variety of creams that helped my stomach. As the years passed, the creams just couldn’t keep up and things spread. When I moved up here, I admitted it was a problem and started seeing a dermatologist. There were more creams and for about six months, I’d drive into Kentucky once or twice a week to get zapped in essentially a very fancy sunbed. As January 2020 came around, the dermatologist suggested that it was time to look into drug-related treatment. There were some new drugs that she’d like to try but wasn’t sure that the insurance company would go for them without trying older ones first. So we were going to start with Humira, which has a reasonable success rate, but a side-effect of lowering your immune system’s effectiveness. We started the process, got approval, got a pharmacy ready to send the first doses…and…

Well, by then it was February or March 2020, and the one thing I didn’t want was a terrible immune system.

My dermatologist agreed with that, so the order was cancelled and things slowly got worse, held back somewhat by inventive use of topical creams and cling film. I got referred to a new dermatologist due to my current one leaving the practice…and I waited a year for an appointment. Never trust Americans that dismiss the NHS because of queues. We still have them, just in different forms.

Anyway, it was May of this year that I finally got to see the new doctor. Such a short visit - barely even ten minutes. They looked at me and said “we’re going to put you on Skyrizi.”

Skyrizi is one of the new class of psoriasis treatments that you’ll see advertised if you spend more than an hour watching American television these days. They’ll tell all the wonderful things it’ll do, as well as the usual litany of side-effects. What they don’t tell you is that it costs roughly $19,000 a dose. Yes, that’s not a typo. Nineteen thousand dollars. And that’s the wholesale price! Actual retail is closer to $30k.

Needless to say, I wasn’t all that confident that the insurance company was going to approve that, but the dermatologist was rather blasé about it. And sure enough, the company did reject the initial request, but a weird test result got us to reject their substitute. What’s weird is that nobody tells you the real price you’re going to pay right up until they’re actually ordering it. Having already looked up the numbers above online weeks before had, I was prepared for the worst, so when they said “it’s going to be a lot…$150 a shot”1 I did almost laugh. I am very lucky that’s not going to cause me an issue every three months.

I took my second shot of it this week, and well, things are progressing. All the flaky skin is gone. I’m no longer leaving bits of me all over the house. My head is pretty much completely clear. My body still has lots of pink patches all over it, but they seem to be getting fainter and fainter with every passing week. It’s basically witchcraft. There are caveats, of course - it can stop working, and I still have to hope that every 12 weeks I don’t have to fight with my insurance company for the next shot, but I hate my body a lot less for the first time in years.

  1. The schedule is that you take two doses a month apart and then a further shot every 12 weeks. ↩︎