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Most people who have rheumatoid arthritis need to take medicine to help reduce symptoms and slow the disease. Rheumatoid arthritis is an autoimmune disorder that causes your joints to swell, get stiff and painful, and eventually break down–leading many to surgery. Unfortunately, the drugs that work best for moderate to severe RA are extremely expensive to make and to buy. These advanced “biologic” drugs are allowing people to go about their daily activities more comfortably than was possible two decades ago.
Fortunately, there are ways to get help with the cost of these drugs. You can turn to patient assistant programs, private foundations and other resources. The first step, though, is to see whether a different, less expensive drug will help you.
What are the different types of RA drugs?
Disease-modifying antirheumatic drugs are the major drug class for treating rheumatoid arthritis. DMARDs can slow and sometimes prevent the breakdown of the joints. There are two main types: nonbiologic and biologic.
- Nonbiologic DMARDs are considered the first-line treatment for RA. The most common ones are methotrexate and leflunomide. They both come as a pill, but methotrexate also comes in the injectable form. You need to take them consistently for weeks or even months before you can tell they are working.
- Biologic DMARDs — also called biologic response modifiers or “biologics” — may be prescribed for people who have more serious disease. There are currently 10 RA biologics: Actemra, Cimzia, Enbrel, Humira, Kineret, Orencia, Remicade, Rituxan, and Simponi. They are all approved by the U.S. Food and Drug Administration for the treatment of RA. None has a generic version yet. Almost all are given intravenously (either as a shot or infused) weekly or monthly.
- Janus Kinase (JAK) Inhibitors are newer to the market and are sometimes referred to as oral biologics, but are actually not biologic agents. Oral pill Xeljanz is the only approved JAK inhibitor on the market for RA.
Your doctor may suggest that you take a pain relief medicine (analgesic) in addition to other treatments. Pain relievers do not affect the course of the disease, but they can help reduce your pain symptoms.
- Acetaminophen (Tylenol) is a common over-the-counter drug that has few side effects as long as the appropriate amount is taken.
- NSAIDs (nonsteroidal anti-inflammatory drugs) include over-the-counter and prescription ibuprofen and naproxen. NSAIDs relieve pain and reduce inflammation.
- Corticosteroids, such as prednisone, also work to control both pain and inflammation. Corticosteroids are given as a pill or by needle and are available only by prescription.
Other drug types may be prescribed for mild RA or for use in combination with one of the drugs above. For example:
- Your doctor may initially suggest sulfasalazine if you have a mild case of RA.
- Hydroxychloroquine (Plaquenil) or chloroquine (Aralen) may be used alone for a mild case or in combination with other DMARDs for more severe RA.
The American College of Rheumatology offers a good explanation of the different types of RA drugs and how they work.
When you work with your doctor to choose a drug for RA, find out how long you will need to take the drug, how well the drug works and the potential side effects.
How much do they cost?
Several websites and smartphone apps allow you to compare drug prices at different pharmacies near you. GoodRx.com, for example, shows the following discounted prices of RA drugs:
|Drug name||Drug class||Yearly cost (rounded)||How often used or quantity|
|Actemra||Biologic DMARD||$11,000||Every 4 weeks|
|Cimzia||Biologic DMARD||$35,000||Every other week|
|Enbrel||Biologic DMARD||$33,000||Once a week|
|Humira*||Biologic DMARD||$32,000||Every other week|
|Kineret||Biologic DMARD||$36,000||Once a day|
|Orencia||Biologic DMARD||$32,000||Once a week|
|Remicade**||Biologic DMARD||$46,000||Every 4 weeks|
|Rituxan***||Biologic DMARD||$15,000||One set of infusions a year|
|Simponi||Biologic DMARD||$35,000||Every 4 weeks|
|Xeljanz||Janus Kinase (JAK) Inhibitor||$30,000||Two pills a day|
|Hydroxychloroquine||Antimalarial||$105||One pill a day|
|Leflunomide||Nonbiologic DMARD||$240||One pill a day|
|Methotrexate||Nonbiologic DMARD||$260||12 pills a month|
|Sulfasalazine||Anti-inflammatory||$140||Two pills a day|
|Acetaminophen (OTC)||Analgesic||$60||Six bottles of 500 pills each|
|Prednisone||Corticosteroid||$75||One pill a day|
|Ibuprofen****||NSAID||$100||Three pills a day, prescription strength|
|Naproxen****||NSAID||$35||Two pills a day|
*Yearly cost is about $63,000 if your dose is once a week.
**Yearly cost is about $23,000 if your dose is every 8 weeks.
***Yearly cost is about $29,000 if you get two sets of infusions.
****You can buy large-quantity bottles over the counter for additional savings.
Other price comparison tools and discount plan offerings include LowestMed.com and Prescription Saver (app available on iTunes). Keep in mind that the drug price may not include the provider’s charge to inject or infuse a medicine.
If you have insurance coverage, call your plan and ask for details about your co-pays, annual deductible, out-of-pocket maximum and any prior authorization requirements. For biologic drugs, a co-pay can be hundreds of dollars each month, which adds up to several thousand dollars a year for co-pays alone.
Why do they cost so much?
Simply put, a lot of time and money has been spent on the research, development and manufacturing process of the specialized medicines. Highly trained scientists use genetic engineering and other complex processes to make these drugs from a living organism. But before drug makers can make and sell a drug, they must invest money in testing. They spend years conducting a series of studies to gather evidence about how well a drug works and whether the benefits outweigh the harms. If the FDA finds the evidence and safety to be sufficient, it will approve the drug. Then, drug makers can advertise and sell the drug. The drug makers price their drugs so that they can recoup some of the costs that went into research and development.
Another reason costs are so high for biologics is that generic versions are not available in the United States. Although the Affordable Care Act of 2010 has a provision to lower the cost of biologic drugs, there are questions about whether the development of generic, “biosimilar” biologics will offer any savings and whether they will even become available in the United States anytime soon. Most of the current RA drugs were FDA-approved before the ACA provision went into effect, so there is little incentive for the makers of those drugs to create a biosimilar option. Plus, the approval process for biosimilar drugs requires extra time (and cost) for clinical studies.
How can you save money on RA drugs?
There are several cost-saving if you take traditional, nonbiologic medicines. First and foremost, go with the generic or over-the-counter version if one is available. If you don’t have insurance, you can check out prescription discount cards and cost comparison tools. You can also ask your doctor whether it’s OK to get a few months’ supply at a time or whether he or she has drug samples or vouchers. You may also wish to look into a certified online pharmacy for cheaper options.
Getting help with the cost of a biologic may take a little more effort, but taking the extra time to do some research should pay off. In addition to discount cards and comparison shopping, here are some other resources.
- Patient assistance programs. The American College of Rheumatology has a list of drug makers and other organizations that have programs to help with the cost of medicines. Check out the websites of the Partnership for Prescription Assistance, Rx Assist, and NeedyMeds to find programs you may qualify for.
- Government assistance programs. The National Conference of State Legislatures lists several sources for state-offered discounts. You can also contact your state government’s health division to find out what kinds of programs it offers.
- Private foundations. Organizations such as the Chronic Disease Fund and HealthWell Foundation offer financial assistance to the populations they serve. Even if they do not currently help with RA drugs, you may want to ask them if and when they might offer that assistance in the future. You can also see whether they know of other foundations that offer funding.
If you decide to try a biologic, Enbrel, Humira, and Orencia are deemed the “Consumer Reports Best Buys.”
Consumer Reports notes that doctors don’t routinely take drug costs into account when they prescribe a medicine, so be sure to raise the subject with your doctor. If you are newly diagnosed and you will be taking medicine, ask your doctor about trying the less costly types of RA medicine first. They have been shown to work just as well as the expensive biologics. Take an active part in your care and work with your doctor to try to delay problems that can end up costing you more money down the road.
Woman with arthritis image via Shutterstock.