Out-of-Pocket Costs Put Arthritis Drugs Out of Reach for Some

May 21, 2010 By Carl Sherman

People with rheumatoid arthritis whose health insurance requires them to pay a higher share of the cost are less likely to use biotech drugs than those with coverage that is more generous. High family medical bills also appear to reduce the use of these powerful but expensive medications, according to a new study in Health Services Research.

Drugs that alter directly — also known as biologics or biological response modifiers — are often effective when conventional drugs fail. Their use for cancer, such as rheumatoid arthritis and other diseases has increased sharply in recent years.

“Our study showed that out-of-pocket cost is a concern in the decision to initiate these drugs,” said lead study author Pinar Karaca-Mandic, Ph.D., an assistant professor in the School of Public Health at the University of Minnesota. “If higher cost-sharing forces people away from preferred, effective therapy, they could end up with higher complication and medical costs.”

The researchers analyzed health insurance data for 35 large private employers during 2000 to 2005 to determine which of 8,557 patients newly diagnosed with rheumatoid arthritis began to use the three most commonly prescribed biotech drugs — etanercept, adalimumab and — and which of the 2,066 patients who used these drugs then stayed on them.

They found that patients who paid more for these drugs were less likely to start taking them and were less likely to continue taking them once started, although the latter effect was smaller.

Patients whose families had high health care expenses were less than half as likely to start biotech drugs as were those from households with average costs. Once they were taking the medication, however, patients continued to use it regardless of family circumstances.

A growing trend among insurers to apply cost-containment strategies such as stiffer coinsurance rates for biotech drugs makes this possibility worrisome, Karaca-Mandic said.

She said that the influence of household finances on biotech drugs use suggests that, “families have a separate budget for health care, and may not be flexible around expanding it. If other members are getting sick, they may want to draw resources away from the patient.”

Kevin Schulman, M.D., a professor of medicine and business administration at Duke University, said that the “real core question is: If innovations come in the form of biologics, do we have a mechanism in place to fund them?”

He said that benefits typically are far more generous for hospital services, “which are not innovative,” than for pharmaceuticals.

“The moral of the story is: As we make choices about benefit design, we shouldn’t blindly pursue what we did yesterday, addressing pharmaceutical costs in the absence of mechanisms to address other parts of the dollar,” Schulman said.

Explore further: Footpaths and parks support active school commute

More information: Karaca-Mandic P, et al. Cost-sharing, family healthcare burden and the use of specialty drugs for rheumatoid arthritis. Health Services Research online, 2010.

Related Stories

Rheumatoid arthritis sends many into early retirement

Feb 04, 2008

A joint study on “The Burden of Rheumatoid Arthritis and Patient Access to Treatments” by authors from the Stockholm School of Economics (Sweden), the University of Lund (Sweden) and the Medical University of Vienna (Austria) ...

Latest rheumatoid arthritis drugs compared

Apr 17, 2008

Findings published today in the open access journal BMC Musculoskeletal Disorders shows that the latest class of drugs used to treat rheumatoid arthritis (RA) are better than standard anti-inflammatories.

Biologics for rheumatoid arthritis work, but which is best?

Oct 07, 2009

More studies that directly compare the effectiveness of different biologic drugs for rheumatoid arthritis (RA) are needed, say Cochrane Researchers. The researchers reviewed all previous Cochrane Systematic Reviews assessing ...

New guidelines for treating rheumatoid arthritis

Jul 22, 2008

Proven combinations of medicines and the introduction of new anti-arthritis drugs have significantly improved the treatment of rheumatoid arthritis (RA), according to guidelines issued by the American College of Rheumatology ...

Recommended for you

Footpaths and parks support active school commute

5 hours ago

While it probably won't make the idea of attending school more appealing social scientists say different infrastructure and behaviour change programs are key to encouraging young people to take a more active ...

Food barometer measures a population’'s eating habits

6 hours ago

A survey by Taylor's-Toulouse University Centre (TTUC) is collecting data on the food habits of individuals and how their choices are related to modernisation and other social factors. Results show that almost ...

Who you gonna call? Beijing smokebusters to go on patrol

11 hours ago

China's capital seeks to snuff out smoking in indoor public places on Monday with a new ban, unprecedented fines and a hotline to report offenders, but enforcement is doubtful in one of the world's most tobacco-addicted countries.

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.