RA medications require unique cost considerations

When it comes to managing rheumatoid arthritis (RA) drugs, cost comes in various sizes and shapes, according to experts. 

Evans

“Traditionally, the easiest understanding of cost is to compare one standard unit of treatment to another, or the cost of acquisition in procurement terms,” says Todd Evans, director, strategy, sales and marketing, pharma/life sciences, health advisory industries at PwC. “However, looking at RA treatment, rheumatologists manage dosing rates as a means of fine tuning treatment, hoping to meet and prolong the clinical impact and the needs of the patient in managing the condition. This means that not all patients are receiving the same overall experienced cost per treatment. Yet, there is continued focus on ‘cost’ per unit in the game of negotiation.”

Even more surprising for cost is that patients rarely present themselves as single condition patients that only require their RA to be treated, Evans says. “The fact is that many RA patients may also have chronic conditions, mental conditions and other immunological diseases. Two, three and four comorbidities in an RA patient converts to a total cost of care explosion by comparison, dwarfing the cost and savings of unit-based cost management,” he says. “Significantly, ‘cost’ in this case is also compounded for the payer since failure to manage RA can become so aggravating to the patient that other conditions worsen and then require costly acute interventions and even institutionalization.”

In addition, injectables, infused and oral RA treatments carry differing levels of cost to administer the drug, Evans says. “However, looking ahead, physician employment mitigates against drug selection based upon how a physician may be inclined to favor treatments that optimize their incomes, all other factors being equal,” he says. “Reducing the impact of method of administration and its reimbursement impact to physicians enables a laser focus on clinical optimization as a primary and even sole focus.”

Finally, Evans says that bundled payments and capitated arrangements with health systems could encourage a total cost of care consideration for the RA patient, which diminishes drug to drug comparison claims since a total view of patient conditions and costs become the comparator with real-world variables not often captured in clinical trials.

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