Optimizing Efficacy and Cost in RA Treatment

Growing evidence suggests expensive rheumatoid arthritis therapies may not lead to better outcomes.

Rheumatoid arthritis (RA), an autoimmune disorder, causes painful swelling in joints that can gradually wear away bone and cause joint damage. It affects more than 1.5 million Americans, often beginning in middle age. Because there is no cure, treatments to slow and prevent progression of the disease are lifelong and can be very costly.

Biologic therapies are increasingly popular for treating RA and there are many new, but expensive, options available. However, there is a growing body of evidence that these expensive therapies may not lead to better patient outcomes. In fact, several clinical trials have suggested that a regimen of three non-biologic generic medications, known as triple therapy, is therapeutically equivalent and more cost effective in managing disease progression when compared to more expensive biologic drugs. In addition, clinical guidelines from the American College of Rheumatology recommend triple therapy as an effective treatment option for patients with RA who have started therapy with a single non-biologic drug without success.

Despite this evidence, a study from the CVS Health Research Institute, published in Arthritis and Rheumatology, showed there is low utilization of triple therapy versus biologic options in clinical practice. In fact, researchers analyzed insurance claims data of nearly 25,000 RA patients on a monotherapy (i.e., treatment with a single drug) over a five-year period and found that just 0.7 percent of those patients intensified their treatment to triple therapy compared to 11.1 percent who intensified to a biologic drug.

At CVS Health, we are focused on addressing the unique needs of our patients and improving health outcomes for this debilitating chronic disease while driving savings for both clients and patients. This research uncovers a concrete and important opportunity for payers to achieve desirable health outcomes at a lower cost, and the findings support our overall approach to RA management. For example, we encourage generics as first line therapies for RA treatment in those newly diagnosed before moving to more expensive biologics, and for those with advanced stages of the disease, our focus is helping to maximize treatment while minimizing costs by encouraging the lowest cost site of care when an infused biologic therapy is required.