“Biosimilars may be priced lower than the reference biologic, but there will need to be better open access to the lower-cost alternative,” Dr. Perkins says.
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Explore This IssueOctober 2018
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Dr. Gibofsky envisions a time in the near future when some bio-originators will become lower in price to compete with biosimilars. “I haven’t yet seen a significant reduction in cost to the patient. It’s difficult to say to a patient, ‘I’m putting you on this drug to save money,’ when the savings aren’t realized by the patient,” he says.
The maze of prior authorization, insurance formularies & ever-changing drug costs has led … to frustration when rheumatologists get caught in the middle. Dr. Greer has had patients lash out at him when they haven’t received their medication.
What Patients Do to Cope
In a move to keep costs lower, rheumatologists have heard of patients who will use their prescribed drugs less frequently. “Patients with high yearly deductibles whose health is stable sometimes decide to forgo therapy in January, when the deductible renews and forces them to pay out of pocket,” Dr. Worthing says. “This often leads to disease flares weeks or months later.”
Some patients who do self-injections of subcutaneous medications will do those injections less frequently than recommended. “They’ll find that sweet spot when it’s only just a little uncomfortable. They’ll take a dose every five to six weeks instead of every four weeks,” Dr. Gibofsky says. “There’s nothing more frustrating than that seesaw pattern. We often counsel patients that you may feel well, but that’s not a reason to interrupt your medications. We may be able to do that on a formal basis, but I don’t advise spacing out medications on an informal basis.”
Another move seen by rheumatologists is a reliance on nonapproved therapies instead of expensive medications, Dr. Greer says. He has seen patients who have felt reasonably better using such products as turmeric, fish oil or glucosamine chondroitin. “Some have a good benefit from them, but they don’t control diseases of a destructive nature,” he says.
What can rheumatologists do to help patients who can’t always afford their medications?
8 Tips to Help with Medication Costs
1. Explain why the drug is needed. This may not change a patient’s economic situation, but it does give insight into the cost-vs.-benefit issue, Dr. Perkins says. “I explain to the patient what medications are indicated for their illness that may be more affordable and why those medications may or may not be right for them. These lower-cost retail medications and generics may still be costly to the patient. In addition, it is important they realize if they require an advanced therapy that we term a specialty medication—even though they are very expensive to the plan—that ways [exist] to lower their out-of-pocket expense.”