The Increasing Costs of RA Medications
Does it feel like you’re paying more and more for your rheumatoid arthritis drugs each year? If so, you’re not alone, as many patients have watched the cost of their RA prescriptions increase far more than the rate of inflation. Express Scripts, the largest pharmacy benefit management company in the U.S., just released a report on 2015 drug price trends. The report indicates that prescriptions used to treat inflammatory conditions, including rheumatoid arthritis, are driving up the total amount spent annually on medications nationwide.1 While U.S. spending on prescription drugs rose by 5.2% in 2015, the amount spent on specialty medications, including the biologic drugs many people take for moderate to severe RA, rose by 18%.
RA: An expensive condition
In determining which conditions are most expensive to cover, Express Scripts examined the amounts spent on various categories of drugs “per member per year.” In other words, they examine the cost of certain drugs averaged over all of their customers, regardless of what medications they are taking. When looking at these numbers, it becomes readily apparent that RA is indeed one expensive condition.
For instance, when looking at the per member per year [PMPY] cost of traditional medications, the “Pain/Inflammation” category of drugs is second only to Diabetes in terms of having the highest cost, at a price tag of $40.65 PMPY (remember, this figure is derived by taking the cost spent on these drugs in 2015 and dividing it by every single Express Scripts customer). When looking at the cost of specialty medications, “Inflammatory Conditions” topped the chart at $89.10 PMPY, with Multiple Sclerosis coming in a distant second at $53.31 PMPY.
Not only are the costs of specialty drugs used to treat inflammatory conditions such as RA the highest of all categories, they are also rising each year. The report states that the prices of Enbrel and Humira Pen increased by a whopping 17% in 2015. Compare this to the inflation rate for the U.S., which was 0.7% in 2015.2 Express Scripts anticipates that “biosimilars” (cheaper, “copycat” versions of biologic medications) will soon be released for Remicade and Humira, which could lead to large cost savings. For instance, Express Scripts anticipates that the release of the biosimilar of Remicade, which is currently awaiting FDA approval, could lead to $17 billion in savings over 10 years.3
However, drug manufacturers are not making the road to FDA approval easy for makers of biosimilars. For example, a recent Wall Street Journal article reported that the makers of Humira have taken out 70 patents for the drug.4 This tactic allows the company to keep the biosimilar versions of Humira off the market until 2022 or later, in spite of the original Humira patent expiring in December 2016. While drug manufacturers argue they need to protect their profits in order to continue developing new, sophisticated drugs (and these profits are high, with Humira accounting for $14 billion in sales in 2015), those of us with rheumatoid arthritis are sometimes unable to afford the biologic medications that could increase our quality of life. An example of this is the cost of Enbrel, which is covered by some but not all Medicare plans, and can amount to $50,000/year in out-of-pocket expenses for patients without insurance plans covering the drug.5 I mention Medicare specifically, as manufacturers often offer co-pay assistance programs to patients covered by health insurance, yet these programs do not extend to Medicare patients. (Note: Since this article was written some Humira biosimilars have been approved by the FDA)
Some assistance from insurance and drug companies
As the costs of RA biologics are so very high, insurance companies are working to provide some options to encourage customers to “shop around” for the best prices. (While one might assume that prices would be the same from one provider to the next, it turns out this is not the case.) For example, I receive insurance coverage with BlueCross BlueShield through my employer, and it has partnered with CastLight Health, a company that provides cost comparisons for medical services. In addition, NPR did an interview with a company called Vitals SmartShopper, which actually pays members cash bonuses to go with cheaper medical service options.6 They are able to do this by partnering with insurance companies and employers, who are happy to provide cash bonuses to their customers if it means huge savings for them. The interview cited that patients receiving Remicade infusions stand to benefit the most, as they can receive up to $500 cash for each monthly treatment. One may wonder how these companies could afford to pay customers $6,000 a year just to receive their infusion at a different location. However, the interview cites that an insurance company or employer can save $200,000 a year just by having a patient shop around for the least expensive infusion-provider.
As I am on Orencia infusions myself, I was eager to try this program out to discover if I could benefit from this program, but unfortunately, Vitals SmartShopper is not yet working with my insurance provider, so I can’t provide a first-hand account of using the service. However, I certainly hope that more and more creative ways of addressing the very high costs of being a patient with rheumatoid arthritis will become available, as too many people are simply unable to afford the medications that might give them significant relief and impact their disease trajectory for the better if they had access to these treatments.
Have you gotten the COVID-19 vaccine yet?