Arthritis Medications

New Arthritis Medications: Reaching the year 2008 new opcions for arthritis appears. Nowhere in the practice of rheumatology is this change more obvious than in the use of the new cytokine blockers or the so-called “biological” medications. One month's supply of one of the new biological medications can average approximately $1000. Other systems, such as Medicare, limit use based on legislatively-mandated delivery restrictions. Taking a Decision New biological medications are undoubtedly more expensive than our previous treatments. In perspective however, they are not any more expensive than the bio­logical treatments for other diseases such as hepatitis C, multiple sclerosis or lymphoma. They are cost-saving in many aspects as well, in allowing patients to return to work, improving earning capacity and avoiding costly joint replacement surgeries. Conversely, the social and emotional costs of inadequate rheumatic treatments are high. When insurers use the excuse of high cost to refuse biological treatment, they are often operating on a very limited and often short-sighted view of costs, and not including the societal or patient-centered costs. In fact, it is accepted practice in the private insurance industry to make policy decisions that impact the future of merely one or two fiscal quarters. For the patient, the physician (who bears responsibility for the therapy) and for society, this is unacceptable. Cost Considerations Elaborate "preauthorization requirements" such as qualifying HAQ scores or other tests used in research studies, or failure of numerous less expensive medica­tions in a specific sequence (so-called “step therapy”) are not justified. Reserpine failure is not required before one can use a newer anti-hypertensive. Rheumatologists deserve no less degree of professional prescribing authority than other physicians such as cardiologists. Furthermore, prescribing a less effective medication because a third party payer requires it may be ethically and legally compromising the physician-patient relationship. Spectrum of Use Lastly, the new biological medications are effective for an ever-increasing list of rheumatic diseases that are cytokine dependent. Third party payers have tried to restrict biologic use by restrictive criteria that demand FDA approval before utilization. Even when there is sub­stantial medical literature testifying to a biologic's effi­cacy, the payer may consider it investigational if FDA approval is lacking and, therefore, deny access. Many of the rare rheumatic diseases may never have a specific FDA indication for their treatments, so to demand FDA approval before allowing use is unwarranted. One can only imagine how many Wegner’s patients would have died if we had restricted our treatments to only FDA-approved medications for this disease. Conclusion The delivery of rheumatic care is becoming increasingly complex as it becomes more effective. The American College of Rheumatology & Arthritis pain relief is committed to protecting the physician-patient relationship and to continued advocacy for the patient, the rheumatologist and soci­ety. We hope that dissemination of this document can make those goals more reachable. Our specialties unparallel expertise in develop­ing and evaluating new treatments for the cure of arthritis symptoms must go hand in hand with our ability to champion for the patient. Educating the payers and advocating for the patient are part of our societal role