Expert Guidance from the ACR/ARP Access in Rheumatology Meeting

Dr. Phillips

Additionally, he recommended delegating tasks to nurse practitioners within the parameters of what is legal in each state, as well as insuring drugs in case of a power outage or other emergency. Dr. Phillips emphasized the necessity of being prepared for contingencies and never infusing without a clinician on site.

As with the two preceding speakers, Dr. Phillips recommended keeping a close watch on drug prices, to buy in bulk when prices are low and not to hesitate to negotiate or switch vendors.

Optimize Patient Access to Treatment

Colin Edgerton, MD, RhMSUS, opened the second session with a presentation about biosimilars. Dr. Edgerton is a founding member of Articularis Healthcare, one of the largest rheumatology practices in the U.S., spanning the states of South Carolina and Georgia. Biosimilars can be a great option for patients and can make treatment more financially accessible, he said. In his experience, patients adhere to their medication regimens equally regardless of whether the drug is the originator or a biosimilar, and the efficacy of the drug itself is not reduced.

Dr. Edgerton identified some challenges related to the use of biosimilars, such as complications with prior authorization and clinical concern regarding multiple prescription switches.

“We don’t want a patient getting changed to another adalimumab every quarter or two,” said Dr. Edgerton. Multiple switches in medications may even cause a nocebo effect for patients, who may be understandably confused or anxious about having to adjust to a new drug.

Mr. Turkas

Nicholas Turkas, MS, is the senior director of patient education and community connections for the Arthritis Foundation. Mr. Turkas’s presentation explored the pros and cons of original Medicare vs. Medicare Advantage plans. Original Medicare is a fee-for-service program, which means there is a set, non-negotiable price for any given procedure. Medicare Advantage, however, is managed care, which requires patients to use a limited network of providers and has stricter rules around prior authorization. When patients near age 65, Mr. Turkas recommends having a discussion with them about switching to Medicare, which has “huge implications in terms of access to care.”

Patients may be drawn to Medicare Advantage plans because of the lower up-front cost and such benefits as gym memberships. Medicare Advantage plans may also offer coverage for some care that original Medicare does not, such as vision, dental or hearing. However, the limitations of Medicare Advantage may make care much more expensive for patients switching from original Medicare, and because plan coverage specifics change from year to year, patients may not always be able to see the same doctor.