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April 29, 2015
Copayments on DMARDs Too Much for Many RA
Patients With Medicare San Francisco—Which drugs pharmacists fill for rheumatoid arthritis (RA) may have as much to do with what the patients can afford than which drugs are most effective to control their illness. A new study, published recently in the journal Arthritis & Rheumatology, found that, in starting a single biologic disease–modifying antirheumatic drug (DMARD), Medicare patients face more than $2,700 in copayments each year before receiving relief from catastrophic coverage. In fact, according to the study led by University of California San Francisco researchers, indicate that, during the initial phase of coverage, patients have to pay a staggering 29.6% of total biologic drugs costs out-of-pocket. Although some newer DMARDs cost more than $20,000 annually, they have become a standard component of guideline-based care for RA. The study cites a recent report by GBI Research estimating that the U.S. market for RA treatment will increase from $6.4 billion in 2013 to $9.3 billion by 2020; one driver is the increase in RA prevalence, which is expected to reach 1.68 million by 2020. The recent research determined that patients face high initial copayments, then fall into the coverage gap or “donut hole” by February or March at which point their cost-sharing can increase to 45% until they reach catastrophic coverage, usually by July. After that, 95% of the cost of the biologic DMARD usually is borne by taxpayers, insurers and pharmaceutical companies, according to the study. The authors note that a previous study of 1,100 adults with RA found that one in six decreased their medication because of cost. “While specialty DMARDs have improved the lives of those with chronic diseases like RA, many patients face a growing and unacceptable financial burden for access to treatment,” said lead author Jinoos Yazdany, MD. “Rather than determining which drug is best for the patient, we find ourselves making treatment decisions based on whether patients can afford drugs.” For the study, the researchers analyzed the formularies of 2,737 Medicare Part D plans in 50 states and Washington, DC, using the January 2013 Centers for Medicare and Medicaid Services Prescription Drug Plan Formulary and Pharmacy Network Files. Nine biologic medications -- abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab, tocilizumab -- and nine non-biologic DMARDs, zathioprine, cuprimine, cyclophosphamide, cyclosporine, hydroxychloroquine, leflunomide, methotrexate, minocycline, as well as sulfasalazine, were analyzed. The study found that, although nearly all Part D plans covered at least one biologic DMARD, access was tightly controlled, with 95% of plans requiring prior authorization. A coinsurance averaging 30% of the drug cost rather than a fixed copayment amount was required by between 81% and 100% of plans. |
U.S. Pharmacist Social Connect
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