High Cost Rheumatoid Arthritis Drugs Create Large Burden for Patients

Nearly 30% of total biologic drug costs paid out-of-pocket.

High co-pays when starting treatment with biologic drugs is creating a significant financial burden for patients with rheumatic diseases such as rheumatoid arthritis (RA), recent analysis revealed.

In a study published in Arthritis & Rheumatology, researchers conducted the first national evaluation of of Medicare coverage for biologic disease modifying anti-rheumatic drugs (DMARDs). The researchers found that starting a single biologic DMARD costs more than $2700 in annual co-payments before patients receive financial relief from catastrophic coverage.

The study also showed that in the initial phase of coverage, most patients can expect to pay a startling 29.6% of total biologic drugs costs out-of-pocket. DMARD treatment, which is a standard part of guideline-based care, can exceed $20,000 in annual costs, according to the study.

A report from GBI Research cited in the study estimates the US market for RA treatment will grow from $6.4 billion in 2013 to $9.3 billion by 2020 as a result of increased RA prevalence. A prior study that evaluated 1100 RA patients found that 1 in 6 decreased their medication due to the high cost.

"While specialty DMARDs have improved the lives of those with chronic diseases like RA, many patients face a growing and unacceptable financial burden for access to treatment," current study lead author Jinoos Yazdany, MD, said in a press release. "Rather than determining which drug is best for the patient, we find ourselves making treatment decisions based on whether patients can afford drugs.”

The researchers evaluated formularies from 2737 Medicare Part D plans in 50 states and Washington, DC, which included 9 biologic medications (abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab, tocilizumab) and 9 non-biologic DMARDs (azathioprine, cuprimine, cyclophosphamide, cyclosporine, hydroxychloroquine, leflunomide, methotrexate, minocycline, and sulfasalazine).

While nearly all Part D plans nationwide covered at least 1 biologic DMARD, access to these treatments are tightly controlled, as 95% of plans require prior authorization. Between 81% and 100% of plans require a coinsurance average of 30% of the total drug cost instead of a fixed co-pay amount.

"Insurance payment reforms have been suggested by the US government, but are not widely implemented in the health care system," Dr. Yazdany said. "With the high cost of biologic DMARDS for RA, many patients are strapped with a substantial financial burden. Americans, especially those patients with chronic conditions such as RA, may be better served by payment and drug coverage reforms that look to decrease rising out-of-pocket costs for patients while keeping total costs in check."