Background Rheumatoid Arthritis (RA) has a worldwide distribution, affecting up to 1% of the US adult population. The estimated costs of treatment for RA was $29 billion in 2004, with direct medical costs of $9,519/case/year in 2001 and $19,016/case/year with use of biologics. With passage of the Affordable Care Act on 3/23/10, the CA Medicaid (Medi-Cal) population increased to 12 million enrollees. The CA Department of Health Care Services (DHCS) Medi-Cal DUR Board is responsible for retrospective/prospective drug utilization monitoring for this underserved population and providing education to healthcare providers regarding appropriate cost-effective/cost-conscious care, including use of costly biologics. Medical literature on cost comparison of arthritis medications for this population is limited.
Objectives To develop a novel strategy for performing relative cost comparisons of a disease-specific (i.e. inflammatory arthritis) medication category for education of healthcare providers that will also comply with the state government contractual requirements for cost confidentiality with pharmaceutical companies.
Methods 1. Board review of quarterly Drug Utilization Reports on highly utilized and/or costly medications. 2. The Medi-Cal DUR “Relative Cost of Arthritis Medications Workgroup” formed in 2013 with physicians, pharmacists, Medi-Cal staff meeting every 2-4 months. 3. Consensus to use 2014 Wholesale Acquisition Cost (WAC) which represents the published catalog or list price for a drug product to wholesalers as reported by the manufacturer (WAC does not represent actual transaction prices and does not include prompt pay or other discounts, rebates or reductions in price). 4. Relative cost of selected arthritis medications assigned number of dollar ($) signs from one $ to four $$$$ signs, where one $ = WAC cost <$25/month and four $$$$ = WAC cost >$1000/month. A - sign signifies cost would be on the lower end and a + sign on the higher end of a category cost range. 5. Recognition of limitations.
Results The CA DHCS Medi-Cal DUR “Relative Cost of Arthritis Medications Workgroup” Table summary:
Conclusions To better educate healthcare providers caring for the enlarging CA Medicaid population on cost-effective/cost-conscious care for patients with chronic inflammatory polyarthritis such as RA, a summary Table entitled “Selected FDA-Approved Arthritis Medications: Relative Average Monthly Cost Based on Wholesale Acquisition Cost (WAC)” was developed, with relative cost of selected arthritis medications assigned varying number of dollar ($) signs ranging from one $ sign to four $$$$ signs (and that also complied with the state government contractual requirements for cost confidentiality with pharmaceutical companies). This new strategy for performing relative cost comparisons will be applied to other Medi-Cal disease-specific medication categories. However, limitations of this strategy need to be recognized, including need for better true-cost transparency.
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Birnbaum H, et al. Curr Med Res Opin. 2010:26(1):77-90.
Acknowledgements Medi-Cal DUR Board members & staff: including T. Albertson, P. Finley, J. McBride, R. Mowers, M. Stebbins; & A. Fingado, S. Lynch.
Disclosure of Interest None declared
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