Advances in Targeted Therapy Selection in Rheumatoid Arthritis - Episode 11

Insurance and Access Challenges in RA

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Nehad Soloman, MD; Joy Schechtman, DO; and Robert Levin, MD, discuss barriers to rheumatoid arthritis (RA) treatment selection such as insurance access.

Nehad Soloman, MD: It sounds like both of you have been using and are comfortable with the tests, and actually implementing change in therapy as a result of these results. Have you faced any challenges with insurance companies covering the test, or in the case that you described, using the test to your advantage?

Joy Schechtman, DO: I have not had any challenges as of yet in using the test. Some of this may change down the line; we don't know, but I think I just look at just trying to do the test in order to give me another tool in my databank and to also allow me to discuss what the outcomes are with insurances. I, like Bob, will write letters to the insurances and say I believe because of the testing and the precision medicine, I want to go to XYZ, and this is the reason why. I haven't really had a lot of difficulties with doing the tests and issues there, but on the other hand, in my decision-making, I think this is a good test to do, whether it's your new rheumatoid patients or patients who have been on biologics that you want to switch and then maybe you weren't doing that test at that time that you started that patient on a biologic. I think it can be used at any time, and we're looking forward to further testing and more precision medicine down the line so that we'll have a little bit more idea if we want to go to TNF [tumor necrosis factor] or a targeted synthetic. I think that we will be more precise in what we're doing to patients earlier on.

Robert Levin, MD: If I can add to what Joy just said. There is some concern that the patients definitely won’t want to be socked with a big bill for a test and that's not covered. We always have a discussion when I'm talking to a patient about the test that they may be responsible for a relatively small portion, but the manufacturer of the test has been very generous in terms of their assistance program and allowing us to get access to treatment or access to the results of the tests and be able to act on it. So, I know that insurance coverage is being worked on, but at this point, a lot of the patient's insurance will not cover the test. You have to mention that and tell them that if there's any problems that … we are, certainly, in my office, they bring the bill in to us, and we help them work through it with the manufacturer. We've had very satisfactory outcomes overall, and I would say that I've had no instance where some patient was stuck with an unreasonable bill that they felt was inappropriate and they didn't have disclosure.

Transcript edited for clarity