Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are chronic and, in many cases, debilitating diseases requiring lifelong treatment. Costs associated with biologic treatment for RA patients not successfully managed on conventional disease-modifying antirheumatic drugs (DMARDs) can be in excess of $30,000 per year. In the effort to curb escalating drug costs associated with treating these chronic, progressive conditions, many health insurers have turned to narrow provider network arrangements and clinical pathways that encourage prescribers to use preferred agents and to achieve cost-control targets. This report focuses on the effect of narrow provider networks and clinical pathways on the use of branded drugs treating moderate to severe RA and SLE. RA is a crowded category of branded biologic drugs, led by three of the longest-used biologic agents: etanercept (Amgen/Pfizer‘s Enbrel), infliximab (Janssen’s Remicade), and adalimumab (AbbVie’s Humira)—all TNF-alpha inhibitors. More-recent agents studied include certolizumab pegol (UCB’s Cimzia), tocilizumab, (Roche’s Actemra), abatacept (Bristol-Myers Squibb’s Orencia), and rituximab (Biogen Idec/Roche’s Rituxan). An oral nonbiologic, tofacitinib (Pfizer’s Xeljanz), is the most recent arrival on the market (2012). Treatment of advanced SLE includes off-label use of DMARDs including Genentech’s CellCept and the B-cell modulator Rituxan, as well as a relatively new rheumatologic agent, belimumab (GlaxoSmithKline’s Benlysta).
Markets covered: United States.
Primary research: Online survey of 101 rheumatologists, 37 MCO medical directors, and 26 MCO pharmacy directors.
Commercial context: Epidemiology tables, drug-treatment algorithms, and managed care background information.
Therapies covered: Drugs used for the treatment of RA and SLE in the following categories: TNF-alpha inhibitors, B-cell-targeted therapies, selective costimulation moderators, IL-6 inhibitors, IL-1 inhibitors, and Jak inhibitors.”