The Alliance for Transparent and Affordable Prescriptions is another resource rheumatologists can use to advocate for regulation of pharmacy benefit manager practices, Dr. Greer says.
“Recently, another janus kinase inhibitor launched at 60% lower than the leading anti-tumor necrosis factor medication, but it will have to be placed as a preferred agent to help with more affordable healthcare options,” Dr. Perkins says. “The pharmacy benefit managers will be key to the solution since they are not incentivized to fill the less expensive options.”
Looking Forward
The current challenges of matching patients with affordable medication makes rheumatologists look forward to future options.
“There is research currently going on that would enable us to select the appropriate drug for a given patient, resulting in less trial and error for various rheumatic diseases, such as RA. This is commonly called precision medicine and should lower costs for patients and insurers,” Dr. Greer says.
It’s also important for providers to stay determined to find coverage for the right treatment, according to Dr. Perkins. “The physician’s office and patient spend enormous time getting their therapy approved. Given these complexities of specialty pharmacies and opportunities for things to break down, it’s imperative the medical team emphasize to the patient to not give up, to call if there are problems with cost or medication delivery, and to realize there are always solutions to getting medication affordably,” she says.
Vanessa Caceres is a medical writer in Bradenton, Fla.
I know this is true. I worked in a family practice setting from 8/1990 until 6/2012. We did a lot of Gold injections, Methotrexate injections, and Remicade infusions. It was harder and harder to get approvals on meds for our patients ! They had to be sent to specialists, who of course charged more !