Sticker shock is alive and well when it comes to medical treatments for rheumatoid arthritis (RA).
Biologics are a common treatment for RA patients — but not a cheap one. On average, patients with rheumatoid arthritis can expect to pay $2,700 or more annually in copayments for biologic drugs.
A recent study published in the Arthritis & Rheumatology journal showed that out-of-pocket expenses for biologic drugs are an astronomical burden on many RA patients on Medicare who pay up to 30 percent in total drug costs for biologics.
Some of the treatments cost more than $10,000 and many of these patients do not work and receive Social Security disability benefits.
There are about 1.3 million Americans living with rheumatoid arthritis — many of whom typically need these specialized treatments. According to a press release from the American College of Rheumatology, a company called GBI Research estimates the U.S. market for RA treatment will increase from $6.4 billion in 2013 to $9.3 billion by 2020.
Finding a Way to Pay the Cost
So what is a patient to do to keep their costs down when the costs of medication continue to skyrocket?
Many drug manufacturers offer rebate programs. There are also programs such as NeedyMeds that can offset costs. Advocates for the American College of Rheumatology and the Arthritis Foundation are consistently lobbying Congress for legislative changes surrounding the high costs and sometimes restrictive guidelines of rheumatoid arthritis drugs.
In a statement, Dr. Jinoos Yazdany of the University of California, San Francisco, School of Medicine, said, “While specialty DMARDs [disease-modifying antirheumatic drugs] have improved the lives of those with chronic diseases like RA, many patients face a growing and unacceptable financial burden for access to treatment. Rather than determining which drug is best for the patient, we find ourselves making treatment decisions based on whether patients can afford drugs.”
Some patients say the costs of these drugs, one of which is Enbrel (generically known as etanercept), are worth it. Others eschew treatment altogether or tweak their treatment schedules because of the hit they take to their finances.
How RA Patients Make It Work
Mika Collins of Auburn Hills, Michigan said, “I use Enbrel. I couldn’t walk without it, and when I lost my healthcare insurance it was $1,800 per box. I sold my car to pay for the Enbrel. Current health insurance covers it at this time, but I am still raising money for a used vehicle.”
Another RA patient, Kelly Zerwas of White Bear Lake, Minnesota, stated, “My husband has wonderful health insurance that covers my Enbrel 100 percent. However, my rheumatologist waited a year trying other medications first because she told me it was so expensive. I wish I would've checked with my insurance instead of taking her word for it. I would've felt better sooner.”
It isn’t always easy to saddle the financial burden, but it’s often times worth it for patients like Robert Smith of Albuquerque, New Mexico. He said, “When I started Enbrel in Florida it was $230 a month. To mitigate the cost my doctor allowed me to take it every 12 to 14 days. Luckily, efficacy only dropped slightly. Now I'm in New Mexico and have Enbrel Support, which is a financial game changer. It's been a financial chess game at times but worth every penny to have my mobility back.”