The Rheumatologist
COVID-19 NewsACR Convergence
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Gout Resource Center
      • Axial Spondyloarthritis Resource Center
      • Psoriatic Arthritis
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / High Cost of DMARDs Could Limit Medicare Patients’ Treatment Adherence

High Cost of DMARDs Could Limit Medicare Patients’ Treatment Adherence

May 29, 2015 • By Richard Quinn

  • Tweet
  • Email
Print-Friendly Version / Save PDF

The high out-of-pocket costs of biologic disease modifying antirheumatic drugs (DMARDs) place “enormous financial strain” on Medicare beneficiaries and may limit therapy adherence, according to the lead author of a national investigation into Part D coverage and cost-sharing structures.

You Might Also Like
  • Medicare Changes Could Have Some Patients Paying More for Drugs
  • RA Patients on DMARDs Have Higher Risk of Infection
  • Implementing Successful Care Management Programs for High-Cost Patients
Also By This Author
  • Celiac Disease in Pediatric Patients

Recently published online in Arthritis & Rheumatology, the study analyzed 2,737 Part D plan formularies for DMARD coverage, prior authorization (PA) requirements and copayments. The study showed 100% of plans covered at least one biologic DMARD, but 95% required a PA and 81% required coinsurance (approximately 30% of drug cost) rather than a fixed co-payment.1 The mean out-of-pocket cost for biologic DMARDs ranged from $2,712 to $2,774 annually. In contrast, six of nine non-biologic DMARDs were covered by 100% of Part D plans without PAs at fixed copayments of $5 to $10 per month.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

“Medicare patients with Part D pharmacy coverage face very high out-of-pocket costs for biologics,” says Jinoos Yazdany, MD, MPH, a rheumatologist at the University of California at San Francisco and chair of the ACR’s National Registry Research and Publications Committee. “High drug costs may limit adherence and put an enormous financial strain on patients. It is important for cost discussions to be part of RA clinical care.

“For many patients, lower cost oral DMARDs are very effective,” Dr. Yazdany adds. “These should be tried first. For patients needing higher cost biologic DMARDs, having accurate information handy to discuss potential out-of-pocket costs and determining what the patient is comfortable paying, are important until policy reforms can address high out-of-pocket costs.”

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Dr. Yazdany, formerly co-chair of the ACR’s Quality Measures Subcommittee and currently serving on the National Quality Forum’s Health Professionals Council, says this study confirms that U.S. health policy is placing a massive financial burden on patients with RA.

“We were surprised to see such high out-of-pocket costs and so little variation in coinsurance requirements (30%) across plans,” she says. “This may be because there is no incentive for plans to offer more generous benefits, since that would risk drawing sicker patients. This study suggests that competition in the healthcare market is unlikely to lead to a significant reduction in out-of-pocket costs for RA patients. Other approaches are urgently needed.

“The way Medicare pays for biologics is complicated,” she says. “For example, obtaining biologic drugs under Medicare’s medical benefit, which covers facility-administered drugs, is often less expensive than obtaining similar drugs in the Part D pharmacy benefit.”

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

Dr. Yazdany urges patients to talk with their rheumatologists about costs and alternatives, and for rheumatologists to encourage their patients to research all of their coverage options.

Richard Quinn is a freelance writer in New Jersey.

Reference
1. Yazdany J, Dudley RA, Chen R, et al. Coverage for high-cost specialty drugs for rheumatoid arthritis in Medicare part D. 2015. Arthritis Rheumatol. Jun;67(6):1474–1480.

Pages: 1 2 | Multi-Page

Filed Under: DMARDs & Immunosuppressives, Drug Updates, Practice Management Tagged With: cost, disease-modifying antirheumatic drugs, DMARD, Medicare, rheumatologist

You Might Also Like:
  • Medicare Changes Could Have Some Patients Paying More for Drugs
  • RA Patients on DMARDs Have Higher Risk of Infection
  • Implementing Successful Care Management Programs for High-Cost Patients
  • High Cost of Rheumatoid Arthritis Medications Burdens Patients in Saudi Arabia

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

Simple Tasks

Learn more about the ACR’s public awareness campaign and how you can get involved. Help increase visibility of rheumatic diseases and decrease the number of people left untreated.

Visit the Simple Tasks site »

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use / Cookie Preferences

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2023 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)