Rheumatoid arthritis

Call to bring biologic prescribing into the 21st Century

A group of rheumatologists have renewed calls for the development of an electronic database and prescribing system to replace the ‘outdated’ current written documentation process used by clinicians to access subsidised biologics for their patients.

They say something must be done to address the rising cost of publicly funded biological disease-modifying antirheumatic drugs (bDMARDs), while also finding a way to capture the data from the prescribing system to maximise patient care and help better predict expenditure.

“They’re on the right track but it’s time to streamline the process,” one of the authors Dr Susanna Proudman told the limbic.

Writing in an MJA clinical focus this month Dr Proudman and her co-authors reflected on 10 years of publicly funded bDMARDs, and revealed government expenditure on bDMARD subsidies for RA treatment grew to about $383 million in 2014. Interestingly, uptake of the eight bDMARDs now available varies greatly.

For some drugs, expenditure has been less than predicted, while for others, costs have blown out. For example the combined expenditure on tocilizumab, certolizumab pegol and golimumab (added to the PBS in 2010) was $93 million in 2014, which was 210% over the initial estimate.

Dr Proudman told the limbic there was no doubt that accessing high-cost medicines through the PBS was a challenge, for clinicians, patients and bureaucrats.

She described the current protocol for completing and lodging extensive written authorities documenting both eligibility to initiate and response to permit continuation as “a very 19th century way about doing things”, but was also a missed opportunity when it came to data collection and research into the use of bDMARDs.

“Ten years of documentation on clinical and laboratory finding indicating eligibility to initiate and continue on bDMARDs remain unused,” she and her co-authors wrote.

“These data represent an untapped opportunity to promote quality use of bDMARDs and biosimilars and to improve cost predictions for high cost drugs.”

Dr Proudman conceded establishing an electronic system to replace the existing procedure would not come cheap, but she said it could also be adapted for other treatments, and the data that would be available could be invaluable when it came to improving the use of the medicines, and also being better able to accurately predict future costs.

“The government has spent a lot of money establishing these high-cost medicine programs, I think automating the process would be very doable and very worthwhile,” she said.

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