The study – published today in the Arthritis & Rheumatology journal of the American College of Rheumatology (ACR) – showed that arthritis patients using a single DMRD face co-payments of $2,700 each year.
The team analysed the formularies of 2,737 Medicare Part D plans, focusing on abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab, tocilizumab as well as nine non-biologic DMARDs.
They found that, although nearly all Part D plans cover at least one DMARD, access was tightly controlled with “95% of plans requiring prior authorization.”
In addition, between 81% and 100% of plans required a coinsurance averaging 30% of the drug cost rather than a fixed co-payment amount
Lead author Jinoos Yazdany from the University of California, San Francisco said: “With the high cost of biologic DMARDS for RA, many patients are strapped with a substantial financial burden."
She added that: “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.”
No biosimilars for RA medications are currently available in the US, although several are being developed.
But, Yazdany is not confident their availability will have a significant impact on RA sufferers’ costs.
She told BioPharma-Repoert.com that: “I expect that biosimilars will slightly reduce or at least stabilize medication costs for patients with RA.
“However, I am concerned that patients will continue to have a high cost burden if insurers keep these new drugs in specialty tiers, which require very high patient cost-sharing. We expect the first biosimilars to be approved for RA in the next few years.”
Full citation: “Coverage For High Cost Specialty Drugs for Rheumatoid Arthritis in Medicare Part D.” Jinoos Yazdany, R. Adams Dudley, Randi Chen, Grace A. Lin and Chien-Wen Tseng.
Source Arthritis & Rheumatology; Published Online: April 21, 2015 (DOI: 10.1002/art.39079).