Higher co-pays limit access to more effective arthritis drugs

Biotech drugs used to treat people suffering from rheumatoid arthritis cost as much as 10 times more than conventional medicine. But often they are also more effective.

But a new study shows that arthritis sufferers are less likely to use these more powerful drugs if their health insurance provider requires a higher co-pay to purchase them.

University of Minnesota health policy professor Pinar Karaca-Mandic, the study’s lead researcher, says that overall spending for this class of drugs has grown dramatically.

“So, it’s understandable that benefit managers have to be more interested in monitoring and containing utilization of these drugs. The key question is how to do it,” she says.

Target those most at risk, she says

Karaca–Mandic adds that health insurance companies need to establish more flexible guidelines that ensure that those who would truly benefit from the drugs can afford to take them.

“If high cost sharing across the board forces some of these people in need — in true need — away from the preferred therapies, then it may end up producing more complications and potentially higher overall health care costs,” she says. “So, it’s really important to understand the effects of the benefits and to be able to target those at most risk. And once you identify those in real need, increasing patients’ out-of-pocket makes little sense.”

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