Yazdany J, Dudley RA, Chen R et al. Coverage for high cost specialty drugs for rheumatoid arthritis in medicare part D. Arthritis Rheumatol. 2015; Apr 21. doi: 10.1002/art.39079. [Epub ahead of print]
Here's the real treatment your average rheumatoid arthritis (RA) patient on Medicare gets after you prescribe a biologic disease-modifying antirheumatic drug (DMARD):
• Forks over a staggering 30% of the cost out-of-pocket for several months (on average about $2,700 a month).
• Falls into the Medicare "donut hole" and shells out 45% of the cost for a while.
• Runs out of money, attains "catastrophic" coverage, and finally faces only 5% of costs (with insurers, pharmaceutical companies, and taxpayers picking up the rest of the tab).
Guidelines recommend quick and consistent treatment with DMARDs for RA, note these authors, but their study of Medicare claims data documents how costs are a significant factor in treatment decisions and frequently a barrier to adherence.
The results come from analysis of the 2013 formularies of 2,737 Medicare Part D plans in 50 states and Washington, DC. The article compares the prices of individual biologic DMARDs, which range from under $300 to nearly $3000 a month. Costs of nonbiologic DMARDs were minimal, with copays of about $5 or $10 per month.
A separate survey of patients on DMARDs, released almost concurrent with the study, shows how long it takes many patients to find the right drug and how much they fear being forced to switch away from it.
Conducted by the Global Healthy Living Foundation, an advocacy group for patients with chronic diseases, the survey showed that finding the right biologic took more than a year for 88% of patients and 5 years for 30%. Only a third (32%) found an effective biologic on the first try.
Nearly all patients (86%) said they would favor staying on their current medication even at a cost increase of 20%, rather than switching to a cheaper but less safe or effective alternative. Virtually everyone (98%) favored legislation preventing pharmacists from switching drugs without notifying patients or doctors, and 90% felt that only doctors should decide which biologics a patient should take.
GHLF gave the survey on the web via its online community of arthritis patients, CreakyJoints, polling 177 members living in the United States who are stabilized on biologic treatment.