Patients with RA taking biologics face up to $3466 (AUD) in out-of-pocket costs each year a study of Medicare data in the US reveals.

Dr. Jinoos Yazdany with the Division of Rheumatology at the University of California, San Francisco and lead author of the study (pictured below) said this situation can lead to rheumatologists making treatment decisions based on whether patients can afford drugs rather than what is best for them.

DR. JINOOS YAZDANY.

Her study published in Arthritis & Rheumatology revealed that patients had high initial co-payments before they fell into the coverage gap or “donut hole” where cost-sharing increases to 45% of drug costs (for 2015). At this point they reach ‘catastrophic coverage’ and  taxpayers, insurers and pharmaceutical companies will pick up 95% of the cost of the drugs.

“While specialty DMARDs have improved the lives of those with chronic diseases like RA, many patients face a growing and unacceptable financial burden for access to treatment,” said Dr. Yazdany.

Insurance payment reforms have been suggested by the US government, but are not widely implemented in the health care system, she said.