Key clinical point: Yearly increases in the price of rheumatoid arthritis biologics have largely negated initial savings in out-of-pocket costs tied to the Affordable Care Act.

Major finding: The median list price of the six RA biologics that have been on the market since 2010 increased by a mean of 160% (standard deviation, 17%; range, 136%-180%).

Study details: A cross-sectional analysis of Medicare data from the first quarter of every year from 2010 to 2019.

Disclosures: The study was supported by the Commonwealth Fund and the Leukemia and Lymphoma Society. Dr. Dusetzina reported receiving grants from Arnold Ventures and personal fees from The Institute for Clinical and Economic Review.

Commentary

“A major concern for patients and rheumatologists in planning for long-term use of biologic therapies in RA is out-of-pocket costs, particularly for patients insured under Medicare in the donut hole. Although changes in healthcare policy have led to some protections for Medicare beneficiaries in which patients pay less of a drug’s list price, these costs remain a significant financial concern because even in the “catastrophic phase” after the donut hole, there is no out-of-pocket spending limit.

This study looked at biologic drubs using the CMS formulary from 2010 (or time of entry into the market) through 2019. On average, out-of-pocket drug costs decreased, mostly due to a single decrease in cost exposure from 2010-2011, which for 6 out of 17 drug-strengths examined, did not offset the continuing price increases since. The study does not show that price control measures are ineffective, as patient out of pocket costs did decrease for several of these drugs.

More importantly, however, it shows that costs remain substantial for all of these drugs (on the order of 4,000-6,000/year) and can explain cost-related non-adherence to therapy among Medicare beneficiaries. In addition, as list prices continue to increase, catastrophic phase spending is likely to do so, too, and continues to push the financial burden onto patients.”

Arundathi Jayatilleke, MD

Lewis Katz School of Medicine, Temple University