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Choice between biologic treatments influenced by financial decisions
While use of biologic treatment for Medicare patients with rheumatoid arthritis remained stable from 2006 to 2009, selecting intravenous infusion or injectable anti-tumor necrosis factor agent was influenced by patient costs and physician reimbursement, according to study results.
“Using national data, we found that infusion biologics [16% prevalence] is preferred over self-injectable biologics [11%] in patients enrolled in Medicare with drug benefits,” Jeffrey R. Curtis, MD, MS, MPH, professor at University of Alabama at Birmingham, division of clinical immunology and rheumatology, and colleagues reported.
Jeffrey R. Curtis
Researchers determined the prevalence of use of rheumatoid arthritis (RA) biologics by examining all Medicare data from 2006 to 2009. They also evaluated the factors among patients with RA starting their first anti-tumor necrosis factor (TNF) agent, whether it was infliximab vs. etanercept or adalimumab.
Among Medicare beneficiaries with RA, overall prevalence of biologic use (approximately 27%) given by infusion (15%-16%) or self-injection (10%-11%) remained unchanged through 2009. Physician preference for infused biologics was associated with reimbursement and an increased likelihood of using infliximab as initial anti-TNF agent (highest vs. lowest quartile, OR=7.3; 95% CI, 6.4-8.3) after adjusting for patient characteristics. Lower out-of-pocket payments for injectable biologics (mean cost/prescription; $4.10) were experienced by lower income patients who received state assistance for Medicare coverage, who also were less likely to use infliximab (OR=0.41; 95% CI, 0.37-0.45) compared with etanercept or adalimumab.
“Our study examined the use of biologics among Medicare beneficiaries longitudinally from 2007 through 2009, a period marked by the establishment of Medicare Part D program,” the researchers concluded. “We found that … treatment decisions were strongly associated with preferential coverage and reimbursement for infusion biologics, which may create financial pressures from both patients’ and physicians’ perspectives to make certain therapies more or less accessible. Despite the availability of Part D, high out-of-pocket payments likely limited the impact of this insurance program on increasing patient access to self-injectable biologics.”
Disclosure: See the study for a full list of relevant disclosures.