Dr. Poddar also cites both generic hydroxychloroquine and colchicine, which sells for an average retail price of $162.65 for 30 capsules according to GoodRx.com, as concerns for his patients. “Despite the fact it’s generic, every patient’s insurance is different, and some of my patients may pay $200 for a month’s supply of colchicine. Sometimes, the drug companies give coupons to offset the cost, but some pharmacies won’t accept them. So patients may just go without their drug,” he says. “High uric acid levels can have cardiovascular manifestations, so there are long-term ramifications, not just one joint problem. You can’t just tell these patients to tough it out. It’s not just their joints. These are systemic diseases.”
In his Kingsport, Tenn., rheumatology clinic, Christopher Morris, MD, also cites both colchicine and hydroxychloroquine as “outlandishly expensive, and most of our lupus patients are on generic Plaquenil,” he says. “If they only price a generic a few dollars less than the brand-name drug, there’s really no savings.”
Patients may not understand how their drug coverage on Medicare supplemental plans work when they purchase these policies, says Dr. Morris. They may struggle to pay 20% of the cost of a year’s supply of a drug that costs $25,000. His practice must now devote one full-time staff person just to deal with prior authorizations and insurance company negotiations, he says.
“High-deductible plans may make patients reach a certain level of money spent before they cover the drugs. These patients may have to shell out several thousand dollars before their insurance kicks in,” says Dr. Morris.
Copays Add Up Quickly
Rheumatology health professionals also hear their patients express concerns about high insurance copays adding up quickly for physical therapy and other integrative treatments, says Christine Stamatos, DNP, ANP-C, director of the Fibromyalgia Wellness Center at Northwell Health in Babylon, N.Y.
“I have patients who have to pay $50 for each physical therapy session,” Dr. Stamatos says. “Some patients have insurance policies with a lower premium each month, but very high deductibles, so they may go without their therapy, and this is care that we know is so effective. So it’s frustrating and scary.”
In the rheumatology clinic at the University of Kentucky in Lexington, Associate Professor Elizabeth Salt, PhD, also observes patients delaying care due to higher out-of-pocket costs. “We see decreased healthcare utilization at the beginning of the year when deductibles have not been met, and an increase at the end of the year, trying to get in treatments before the year ends. I see delays in necessary procedures due to cost and patients unable to afford medications due to increased cost,” she says.