Effective coverage and reimbursement strategies for etanercept and infliximab in the treatment of rheumatoid arthritis

Abstract

Early and aggressive treatment of rheumatoid arthritis (RA) can provide cost savings through enhanced and sustained clinical outcomes. Antitumor necrosis factor-alpha (anti-TNF) agents, such as infliximab and etanercept, provide a superior level of clinical benefit, particularly in patients with moderate-to-severe RA. Reimbursement of these agents falls under either a pharmacy or medical benefit, depending on their route of administration. However, inconsistencies in reimbursement strategies across plans potentially restrict clinician and patient access to these safe and effective therapies. Benefits should be designed to ensure that all eligible patients have access to anti-TNF agents, with the understanding that earlier treatment of RA with safe and effective agents provides significant cost savings to future insurers through enhanced and sustained outcomes.