Managed Care Decision Makers: Understanding the Full Scope of Rheumatoid Arthritis Management

Rheumatoid arthritis (RA) is a chronic, progressive autoimmune disease that affects an estimated 0.5% to 1% of the US population, or approximately 1.5 million individuals. The disease exerts a tremendous toll on patient health-related quality of life, driving many patients out of the workforce as their pain, fatigue, and disability grow. Additionally, with direct medical costs estimated at $22.3 billion and indirect and intangible costs of another $50.1 billion, RA also places a significant economic burden on patients, employers, and payers. The advent of disease-modifying antirheumatic drugs in the past 15 years has revolutionized the treatment of RA, slowing progression of the disease and reducing disability. However, the benefits have come with a huge financial cost, as many of these treatments exceed $20,000 a year. These drug prices have risen by double digits in the past 3 years alone. Managed care organizations and other payers are implementing numerous approaches to address the challenge of managing the cost of care for patients with RA while improving outcomes. These include utilization review, controlling site-of-care services, shifting coverage of intravenous specialty drugs from the medical to the pharmacy benefit, improving provider adherence to national and international guidelines, and addressing comorbidities in patients with RA. This challenge will become even greater in the next decade with the introduction of new specialty drugs and the growing incidence of the disease.