Updating Guidelines and Payer Access for Refractory Polymyalgia Rheumatica
Delving into the realm of refractory polymyalgia rheumatica, Robert Spiera, M.D., discusses the potential inclusion of sarilumab in revised guidelines. He addresses payer concerns regarding prior authorization while emphasizing the importance of ensuring appropriate patient access through evidence-based approaches.
This is a video synopsis/summary of a Between the Lines involving Robert Spiera, M.D., and Dana McCormick, R.Ph.
In a discussion between Dana McCormick, R.Ph., and Robert Spiera, M.D., the focus shifts to the integration of sarilumab into current treatment guidelines for polymyalgia rheumatica. Spiera highlights the need for guideline updates, considering the drug’s new indication and the evolving landscape of polymyalgia rheumatica treatment. The existing guidelines aimed to balance effective steroid use without undertreatment, emphasizing the importance of not overlooking other potential conditions.
Spiera anticipates a straightforward incorporation of sarilumab into guidelines, especially for patients who failed steroid tapers or experienced intolerable side effects. He suggests potential expansion to high-risk patients, even if they hadn’t failed a taper, acknowledging the need for conclusive evidence in this regard.
Addressing payer concerns, Spiera emphasizes aligning prior authorization policies with FDA approval. He recommends focusing on patient history, assessing whether they failed a steroid taper or exhibited intolerance. The discussion underscores the importance of capturing data on documented flares and unacceptable steroid-related toxicity. Spiera emphasizes the potential cost savings and improved quality of life associated with incorporating sarilumab as a steroid-sparing agent in polymyalgia rheumatica treatment.
This summary was AI-generated and reviewed by Managed Healthcare Executive® staff.
