ACR’s Recommendations for Controlling Drug Costs, Improving Outcomes

Originally published in Rheumatology Network

Affordability is a leading cause of drug abandonment among rheumatology patients. Out-of-pocket costs can be substantial. For example, rheumatoid arthritis patients pay $5,471 in annual out-of-pocket costs for Humira, according to a report issued by the Kaiser Family Foundation in February.

Back in April, the American College of Rheumatology issued a series of position statements designed to control drug costs while improving patient outcomes.

“The need for patients to have access to prompt affordable, and medically necessary treatments is ongoing and should be considered at every step of the policy making process,” said Colin Edgerton, M.D., a South Carolina rheumatologist who serves as ACR’s committee on rheumatologic care.

The recommendations address:

  • How prescription drug prices are determined. ACR is calling for transparency in policies used by pharmaceutical manufacturers, pharmacy benefit managers and health insurance companies.
  • Less costly treatment alternatives. Specifically, a safe and efficient biosimilar approval pathway.
  • The adoption of comprehensive proposals. These should address costs to the healthcare system, continuity of care and out-of-pocket patient costs.

The ACR stated that cost savings plans should not compromise the quality of care or safe clinical practices. Step therapy, fail-first policies and any rankings of medications based solely on cost should not be a consideration for any cost savings plan, they stated. This includes switching branded products in stable patients solely for cost savings, and especially without the patient’s consent.

Formulary benefits programs by pharmacy review committees should include a rheumatologist on the committee, the ACR stated.

“There is a natural synergy between rheumatologists and pharmacists due to the complexity of our medications. Therefore, working with pharmacists in a team-based approach is ideal,” Dr. Edgerton said in an interview with Rheumatology Network.

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