Reumatologia: pesquisas atuais
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ISSN: 2161-1149 (Printed)
ISSN: 2161-1149 (Printed)
John Boone*, Gary Crump, Rosie Walters
Objective: Step Therapy (ST) policies are implemented by third-party payers to reduce prescription drug costs in Rheumatoid Arthritis (RA), often resulting in payer preference for a Tumour Necrosis Factor inhibitor (TNFi) after patients fail conventional synthetic Disease-Modifying Antirheumatic Drugs (csDMARD) therapy. Commercial availability of PrismRA has provided rheumatologists with a clinically validated, personalized medicine approach for identifying RA patients who might benefit from first-line use of a non-TNFi biologic/targeted synthetic DMARD (b/tsDMARD) after failing csDMARD therapy. We sought to determine the extent to which ST policies impede RA patients’ access to non-TNFi b/tsDMARD therapy when their PrismRA indicated high likelihood of inadequate response to TNFi therapy.
Methods: We performed chart review of all RA patients in our practice whose PrismRA indicated high likelihood of inadequate response to TNFi therapy. We collected data on patients’ previous history of b/tsDMARD exposure, payer identity, and payer approval/rejection determination of the non-TNFi b/tsDMARD prescribed following the PrismRA result.
Results: 150 RA patients had a PrismRA test performed, of which 41 patients had a high likelihood of inadequate response to TNFi therapy and were subsequently prescribed a non-TNFi b/tsDMARD. 71% of patients had their non-TNFi b/tsDMARD approved by their payer without need for appeal. Approval was higher for patients with Medicare coverage (85%) compared commercial insurance (64%), though was similar for patients who were TNFi naïve (76%) and TNFi exposed (65%).
Conclusion: A majority (71%) of RA patients in our practice with a PrismRA indicating high likelihood of inadequate response to TNFi therapy were able to successfully access their non- TNFi b/tsDMARD prescribed in alignment with their PrismRA result.