Updated 19 January 2017

Co-payments for arthritis meds crippling US seniors

Out-of-pocket expenses keep many elderly arthritis patients from taking needed drugs, a study suggests.

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.

Read: Diagnosing rheumatoid arthritis

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.

Read: Symptoms of rheumatoid arthritis

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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Professor Asgar Ali Kalla completed his MBChB (Bachelor of Medicine and Bachelor of Surgery) degree in 1975 at the University of Cape Town and his FRCP in 2003 in London. Professor Ali Kalla is the Isaac Albow Chair of Rheumatology at the University of Cape Town and also the Head of Division of Rheumatology at Groote Schuur Hospital. He has participated in a number of clinical trials for rheumatology and is active in community outreach. Prof Ali Kalla is an expert in Arthritis for Health24.

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