Analysis: Medication Adherence Positively Impacts RA Patients’ Healthcare Costs and Usage

For patients with rheumatoid arthritis, adhering to non-infused biologic drugs as prescribed is linked to lower medical costs, reduced likelihood of hospitalization, and shorter length of stay (LOS), according to a recent study. The research, jointly conducted by AllianceRx Walgreens Pharmacy and Walgreens, was presented last month at the National Association of Specialty Pharmacy (NASP) annual meeting in Grapevine, Texas.

Rheumatoid arthritis (RA) is a chronic condition in which the immune system mistakenly attacks the joints, leading to pain and swelling. About 1.3 million adults in the United States have RA, with 35% experiencing work-related disabilities due to their condition.

Commonly prescribed drugs for RA include etanercept (Enbrel) and adalimumab (Humira), both of which may be administered via subcutaneous injection at home, and tofacitinib (Xeljanz), which is taken orally. Patients with RA may find these types of treatment options more convenient than infused drugs like infliximab (Remicade), which require intravenous (IV) administration at a doctor’s office or clinic.

For this retrospective cohort study, the investigators aimed to understand how better adherence to non-infused biologic RA medications influences patients’ healthcare utilization. They specifically looked at whether any key health outcomes were associated with closely following the prescribed medication plan, as measured by the Pharmacy Quality Alliance (PQA) as proportion of days covered (PDC). The analysis included claims data from commercial and Medicare databases from 2019 to 2020.

“A focus of the study was to validate the PQA “PDC-RA” metric used for adherence calculations based on the direction of the associations between being adherent and outcomes of total medical costs, inpatient admissions, and length of stay,” Francis Staskon, Ph.D., principal analyst, Health Analytics, Research & Reporting, Walgreens, and lead author of the study, told Formulary Watch. “Results are that adherence has a main effect reducing the levels of the mentioned outcomes, after controlling for a number of other demographic, diagnostic, therapy and payer influences on those outcomes.”

The results confirmed that those who stuck with their RA biologic medication regimen tended to spend less on healthcare, had a lower chance of being hospitalized, and had shorter hospital stays. The analysis showed that patients in the more adherent group had much higher biologics costs than those of the less adherent group ($23,369), given they used more medication. However, the adherent group had significantly lower adjusted medical costs than the less adherent group, with a difference of $5,740.

These reductions also depended on age, comorbidity, COVID-19, inflammatory conditions, southern region, and payer type (commercial or Medicare).

Specialty pharmacists play a vital role in actively helping patients manage their RA condition and supporting drug adherence.

Renee Baiano, Pharm.D.

“Specialty pharmacists help patients and caregivers understand the goals of therapy and what they should expect from treatment, including things like potential side effects and how to manage them, how to improve adherence, etc.,” Renee Baiano, Pharm.D., clinical program manager, AllianceRx Walgreens Pharmacy, and an author of the study told Formulary Watch.

Baiano explained that their pharmacists provide in-depth medication management, emphasize the importance of adherence, guide patients in preventing and managing adverse effects, and monitor for worsening symptoms. “Our pharmacists also offer disease-state counseling, connect patients and caregivers to resources, explore all options to help lower costs, and are available 24/7 to provide the best possible care,” she said. “Supporting the patient – and working closely with the patient’s care team and specialty pharmacy – on an individual level can help them stay on medication and improve outcomes financially and with regard to the patient’s well-being.”