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However, patients with low BSA psoriasis and burdensome symptoms who are candidates for biologic therapy (according to the clinicians judgement) may not meet a payers criteria for eligibility to receive advanced psoriasis treatment options [4, 9, 23, 28] Current International Psoriasis Council (IPC), American Academy of Dermatology, and National Psoriasis Foundation treatment guidelines recommend that indicators of psoriasis disease burden beyond BSA, including involvement of high-impact sites and failure of topical therapies, be considered when determining whether patients are eligible for systemic treatment [3, 4]