Background/Purpose: Biologics, a relatively new widely used class of medication that can substantially improve the course of RA, are expensive and their use is not reimbursed by all insurances.  The aim of this study was to determine whether there was a difference in the usage of biologics between RA patients with only Medicare or Medicare-replacement and those who had other insurance coverage.

Methods: Demographic and clinical information, medication history, and insurance data were extracted from the electronic records of all patients with a diagnosis of RA managed at the Dallas Arthritis Center (DAC) for at least 3 months in 2013.  Patients were then stratified into the following categories, based on their type of insurance coverage: 1) Medicare only: Medicare coverage with no supplemental insurance of any kind, and no medication-specific financial support from charitable organizations; 2) Medicare-Medicaid: both Medicare and Medicaid coverage; 3) Medicare integrated: supplemental insurance in addition to Medicare (private or public insurances or Medicare part D); and 4) Private only:private insurance only. Unadjusted odds ratio were used to determine the likelihood of patients with different types of insurance coverage as compared to patients covered exclusively by Medicare.  This latter group was arbitrarily assigned an Odds Ratio of 1.

Results: Our search yielded 529 unique patients (median age 62 years, range 19 to 91; 79% female) with a confirmed diagnosis of RA; 13 patients who received financial support from private foundations to purchase the needed medications were excluded from the analysis.  The remaining 516 patients represent our study group.  Table 1 depicts the distribution of the insurance coverage amongst the study patients:

Insurance	Total patients	Median age	Female (%)
Medicare only	118	70  (41 – 88)	91   (77.1)
Medicare-Medicaid	67	66 (28 – 91)	56   (83.6)
Medicare Integrated	52	68 (36 – 87)	40   (76.9)
Private only	279	56 (19 – 91)	231 (82.8)

 Table 2 shows the relative usage of biologics amongst the different groups:

Insurance	Total RA patients	RA patients on any biologic	% RA patients on any biologic	OR (95% CI)	p
Medicare only	118	22	20%	1
Medicare-Medicaid	67	25	37%	2.44  (1.23 – 4.81)	p<.05
Medicare-Integrated	52	20	38%	2.56  (1.24 – 5.29)	p<.05
Private only	279	102	37%	2.36  (1.39 – 3.99)	p<.001

 

Conclusion: Patients with Medicare only coverage who received no assistance from private foundations were significantly less likely to be treated with biologics than patients with any other type of coverage. In this study, we did not evaluate each patient’s disease activity. Therefore, the possibility that fewer Medicare-only patients needed biologics than patients with other types of coverage must be considered. A study designed to include disease activity as a variable is currently under way. If confirmed, these results suggest that efforts are needed to increase Medicare patients’ access to medications that can significantly improve the course of their disease and quality of life.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/possible-effects-of-medicare-only-insurance-coverage-on-the-use-of-biologics-in-patients-with-ra/