Arthritis medications known as biologic disease-modifying drugs can cost Medicare patients more than $2,700 (±R33 000) in co-payments a year, a new report finds.
Immense burden on patients
Researchers say the tab is an immense burden on patients with disabling conditions such as rheumatoid arthritis, a chronic disorder that affects an estimated 1.3 million Americans.
Biologic anti-rheumatic medications – which include drugs such as adalimumab (Humira), anakinra (Kineret) and etanercept (Enbrel) – have allowed patients to gain better control of rheumatoid arthritis when taken early in the course of disease, the researchers explained.
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But some of the new drugs top $20,000 annually, according to the April 21 online report in the journal Arthritis & Rheumatology.
"Many patients face a growing and unacceptable financial burden for access to treatment," said study lead author Dr. Jinoos Yazdany of the division of rheumatology at the University of California, San Francisco.
Decisions based on whether patients can afford drugs
"Rather than determining which drug is best for the patient, we find ourselves making treatment decisions based on whether patients can afford drugs," Yazdany said in a journal news release.
Patients on Medicare – the publicly funded insurance program for the elderly – must pay about one-third the total drug cost in the initial phase of coverage. Once they reach the "donut hole" coverage cap (usually early in the year), they must pay 45 percent of drug costs until they qualify for catastrophic coverage and pay much less, the researchers said.
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Previous research has suggested that one in six patients lowers his or her medication level because of cost, the researchers added.
The study results are based on an analysis of the drugs allowed to be prescribed to patients in 2,737 plans under Medicare Part D.
Not widely implemented in health care
"Insurance payment reforms have been suggested by the U.S. government, but are not widely implemented in the health care system," Yazdany said in the news release.
"Americans, especially those patients with chronic conditions such as [rheumatoid arthritis], 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," she concluded.
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