Seth Ginsberg, co-founder and president of the Global Healthy Living Foundation, discusses the challenges that patients face in accessing biologic medicines.
What challenges do patients with inflammatory diseases face in accessing biologic therapies?
There are several challenges that patients with inflammatory diseases, like rheumatoid arthritis or RA, face in accessing biologic therapies.
First, patients respond uniquely to biologics. It is impossible for a rheumatologist to predict which medicine might work best in their patients, based on specific criteria. This is in our future, however. Instead, today, patients must often go through a “trial and error” process when they try a medicine for 3 to 6 months to see if there is a positive response. It could take months or even years for a person with arthritis to find an effective therapy. So the challenge here lies in not knowing which biologic to select for optimal results.
Another challenge patients face isn’t related to biology. Rather, it’s related to their wallet. A person’s health insurance—public, private or a combination—will often dictate which medicines are available in their plan’s formulary and affordable based on the required co-pay or deductible. Rheumatologists (and their practice staffs) spend countless hours working with their patients to wade through paperwork and jargon to determine which therapies might be obtainable to the patient. In some cases, patients must go through lengthy approval processes (including prior authorization or “fail first” protocols) to qualify to obtain the medicine prescribed by their physician. It’s not an exaggeration to say that the physician-patient relationship is being undermined by insurance companies (and their partner pharmacy benefit managers) who are making medicine decisions based on dollar signs rather than medical judgement.