Background/Purpose: We
have previously shown that patients with Medicare only coverage without
financial assistance from foundations were significantly less likely to receive
Biologics than patients with other types of coverage (Genta MS, Arthr
Rheumatol, 2014;66:10:S39). In that study we did not evaluate disease
activity. The purpose of the present study was to determine whether Medicare
only patients were less likely to have low disease activity scores than
patients covered by other insurance. 

Methods: Patients with
established RA and DAS28 CRP (DAS) activity score followed in a solo practice
were stratified into the following categories, based on their insurance
coverage: 1) Medicare only: Medicare, no supplemental insurance, no
medication-specific financial support; 2) Medicare Integrated: Medicare with a
supplemental insurance (private or public insurances or Medicare part D); and
3) Private only: by a private insurance only with no public coverage. Three
treatment groups were considered: DMARDs only; DMARDs and Biologics; and
Biologics only. Demographics, median DAS Scores, and disease activity clinical
categories were compared by unadjusted Odds Ratios (OR) and by the t test.

Results: Insurance data
and DAS were available for 163 patients. The Medicare only group included 52
patients (median age 70 years, range 49-88; 77% women; 9 White, 21 African
American and 22 Hispanic). There were 20 patients with Medicare Integrated (age
68, range 46-80; 85% women; 9 White, 8 African American, and 3 Hispanic). Of
the 91 patients with private insurance only (age 59 years, range19-89; 79%
women) 29 were White, 32 African American, and 30 Hispanic. Thus, Medicare only
patients were more likely to be non-White than both other groups (OR 2.49 95%
CI 1.10 – 5.64; p<0.05). Median DAS scores were similar in the three groups
(17, 14, and 20, respectively). Treatment groups and DAS-based clinical
categories are summarized in Table 1.  Although patients with Medicare
only were more likely to be on DMARDs only than patients in the other two
groups (OR 2.29 95% CI 1.14 – 4.60; p<0.02) they were in a DAS Remission or
Low clinical category as frequently as those with other insurance plans who were
more likely to receive Biologics with or without DMARDs.

Conclusion: This study confirms our previous finding that patients with
Medicare only are less likely to receive Biologics than those who have other
insurances. Nevertheless, in this small sample, it appeared that these patients
were not adversely affected by this limitation, as shown by low disease
activity and remission rates similar to those with other types of coverage.