Action Brief WHAT EMPLOYERS NEED TO KNOW ABOUT RHEUMATOID ARTHRITIS
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Action Brief
WHAT EMPLOYERS NEED TO KNOW
ABOUT RHEUMATOID ARTHRITIS
Helping employees be their healthy best, understanding treatment options,
maximizing the value of prescription drugs
Rheumatoid arthritis (RA) is
the most common autoimmune RHEUMATOID ARTHRITIS:
inflammatory disease in the U.S., an autoimmune inflammatory
affecting about 1.3 million people, disease
and resulting in well over $19 billion OSTEOARTHRITIS: causes
in direct (all costs related to medical wear-and-tear over time on
visits and prescriptions to treat joints and cartilage
RA) and indirect costs (includes
health care costs for family members,
The main symptoms are joint
work-loss costs, formal and informal
pain, stiffness and swelling. Some
caregiving, home adaptations, and
people have trouble sleeping and feel
other costs related to the consequences
intensely tired. RA patients also have
of RA).
an increased risk of cardiovascular
Because RA most frequently appears disease, lymphoma, anemia,
between ages 40-60—the prime of osteoporosis, and depression.
working life—employers can play an
important role in helping employees
and their family members get the Because cartilage damage
ACTION STEPS care and treatment they need to lead
healthier, happier, more productive
and bone erosions
FOR EMPLOYERS:
lives, while reducing costs for all. frequently occur within the
1. Work effectively with key
stakeholders ABOUT RHEUMATOID first two years of disease,
2. Design benefits that ARTHRITIS: TREATABLE,
account for high-cost BUT NOT CURABLE rheumatologists now move
conditions RA is a painful, chronic and
3. Tackle the high cost of usually progressive disease that aggressively to DMARDS
occurs when the body’s immune
prescription drugs
system inexplicably starts attacking
early in the course of
4. Provide resources and
and damaging joints and soft tissue disease, usually as soon as a
services to better manage
RA fatigue and pain surrounding the bones. About 75
percent of RA patients are women. diagnosis is confirmed.
Employers may want to
share the National Alliance's
“Five Rights Framework”
with their vendor partners.
It targets critical issues
and opportunities for drug
manufacturers, providers,
health plans, and pharmacy
benefit managers to address.
The framework also raises
purchaser expectations
and enables them to better
understand, evaluate and
There is no pattern to symptoms; improve the specialty drug
Impact of RA-related each patient experiences RA
differently. For example, some have marketplace.
morning stiffness regular “flares,” or periods when
symptoms become suddenly worse,
Affected work • Corticosteroids
performance 47% then subside; others have long periods
of time when the disease is quiet and • Disease-modifying anti-rheumatic
Late arrival at
there are no symptoms. drugs (DMARDs) that come in the
work 33%
form of non-biologics/conventional
Required sick It’s important to diagnose and
synthetics (cDMARDs) and
leave in the past address the disease as early
month 15% the newer, targeted biologics
as possible so symptoms can be
(bDMARDs)
effectively managed, joint and other
damage can be minimized, and The newer bDMARDs often rank among
patients can remain active and enjoy the most costly for employers — some
satisfying, productive lives. Optimal are $50,000 or more per patient, per year.
That’s why it’s important to consider
Has your RA ever gone treatment requires a comprehensive
program that combines medical, social step therapy and other tactics in benefit
into remission? design planning and management.
and emotional patient support.
Employers have the power to drive
collaboration with their vendors
Annual 2013 YES There are three general classes of to control costs, reduce waste, and
survey of more
36% drugs commonly used to treat RA:
than 1,000 NO maximize effectiveness of RA drugs on
people with RA
64% • Non-steroidal anti-inflammatory behalf of their employees. This Action
agents (NSAIDs) Brief offers several strategies to consider.
ACTION STEPS FOR patient needs (e.g., preventive care
EMPLOYERS visits, medication adherence, care DID YOU KNOW?
coordination). Drugs infused in a hospital
1. WORK EFFECTIVELY WITH
Offer workplace policy and outpatient setting can cost
KEY STAKEHOLDERS
environmental changes that help twice as much as if they were
Know the needs and numbers employees with RA avoid or return administered in a doctor’s
of employees and covered family from disability leave, using the office. Smart plan design can
members who are being treated for Job Accommodation Network as a help direct RA patients to the
RA so the formulary aligns with resource. right care, in the right place,
established prescription regimens. at the right time, for the right
Focus on long-term formulary 3. TACKLE THE HIGH COST price.
stability for RA (and other high-cost OF PRESCRIPTION DRUGS
conditions) to ensure continuity of Nearly nine in 10 employers have
Establishing different copays for
care, which can lead to better cost and identified managing pharmacy spending
specialty drugs to promote the
condition management, and result in as their top priority over the next three
use of lower-cost alternatives
less waste, and better outcomes years, according to a recent study
such as biosimilars. Today, 18% of
by Willis Towers Watson. Common
Ensure that personalized employers have done this, a number
strategies employers are using today
patient support is available to that could triple over the next two
include:
assist with medication adherence, years.
Evaluating and renegotiating
multiple-symptom management, and
pharmacy contracts to obtain 4. PROVIDE RESOURCES
appropriate use of potentially high- better pricing. Today, 63% of AND SERVICES TO BETTER
risk medications such as opioids and employers do this; another 31% are MANAGE RA FATIGUE AND
sleep aids. planning or considering this by 2018. PAIN
Ensuring appropriate Obtain data from health plans,
2. DESIGN BENEFITS THAT
ACCOUNT FOR utilization. Today, 61% of PBMS, specialty pharmacies,
HIGH-COST CONDITIONS employers have added programs employee assistance programs
to ensure appropriate use of (EAPs), and workers’ compensation
Consider value-based benefit
prescription drugs, up from 53% in programs to determine opioid use
design for those with chronic and/
2015; 85% are considering doing so among RA patients.
or high-cost conditions to remove
by 2018. Develop a comprehensive care
barriers to care by lowering or
eliminating copayments, deductibles Restricting or excluding the management strategy with vendors
and coinsurance, and limiting out-of- use of certain drugs when to address opioid use, as well as the
pocket costs. equally effective, lower-cost use of medications to treat fatigue
alternatives are available. For (e.g., anemia medicine, sleep aids,
Ensure benefit design reflects
example, 52% of employers exclude psychoactive medicines).
the up-to-date Clinical Practice
compound drugs; another 13% are Create a culture of inclusion by
Guidelines of the American College
considering this action by 2018. allowing needed exercise, therapy and
of Rheumatology (ACR), e.g., step
therapy where csDMARDs are tried With regard to specialty drugs, rest breaks.
for a period of time before more costly strategies growing in popularity include: Provide ongoing employee
bDMARDs are prescribed. ACR Making changes to coverage education to raise awareness of RA
recommends switching to a new MOA to influence where and signs and symptoms, as well as the
when current therapy is not working. how specialty drugs are importance of receiving appropriate
Work with health plans, PBMs, administered. Today, 19% of care, using benefits wisely, and
specialty pharmacies, disease employers have made such changes; understanding coworkers living
management vendors and another 43% are considering them with RA.
others to meet the full range of RA for 2018.RESOURCES FOR RESOURCES FOR ENDNOTES:
EMPLOYERS: EMPLOYEES: 1. What is RA? www.rheumatoidarthritis.net
2. http://www.mayoclinic.org/diseases-conditions/
• American College of Rheumatology • American College of Rheumatology rheumatoid-arthritis/symptoms-causes/dxc-
Clinical Practice Guidelines Patient and Caregiver Resources
20197390
3. http://www.arthritis.org/about-arthritis/
• PowerPoint presentation: How • Choosing Wisely: Treating understanding-arthritis/arthritis-statistics-facts.php
4. https://www.hopkinsarthritis.org/arthritis-info/
Effective Treatments Can Mitigate Rheumatoid Arthritis rheumatoid-arthritis/
Productivity Losses Due to 5. https://rheumatoidarthritis.net/what-is-ra/stages-
• Rheumatoid Arthritis in the and-progression/
Rheumatoid Arthritis
Workplace 6. http://www.arthritis.org/about-arthritis/types/
• Occupation and Risk of Developing rheumatoid-arthritis/treatment.php
• How to Beat Arthritis Fatigue 7. https://www.ncbi.nlm.nih.gov/pmc/articles/
Rheumatoid Arthritis: Results from a PMC5020678/
Population-based Case-control study • Drug-pricing Tiers: How Insurance 8. https://www.willistowerswatson.com/en/
Companies Determine Which Drugs press/2016/11/us-employers-step-up-efforts-to-
• Job Accommodation Network (JAN): manage-high-cost-of-drugs
They’ll Cover—and How Much Their
Employees with Arthritis
Customers Will Pay
National Alliance would like to acknowledge the support
it has received from Sanofi in the form of clinical
expertise and funding to produce this Action Brief.
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