Do Seniors Stop Rheumatoid Arthritis Drugs Due to Cost?

By Vandana Suresh | March 14, 2025

As the United States aged population increases, the incidence of arthritis is expected to climb. However, people in our country experience unequal access to care. Racial and ethnic disparities compounded with socioeconomic and geographic differences directly impact health outcomes. For example, rheumatoid arthritis medications, which often include expensive biologic disease-modifying antirheumatic drugs (DMARDs), pose a significant economic burden on patients that could cause them to abandon their treatment.

The Arthritis Foundation has awarded Aryana Sepassi, PharmD, assistant professor at the University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, a 2024 Rheumatoid Arthritis Research Program award to investigate how rheumatoid arthritis (RA) patients on Medicare make decisions regarding their biologics medication. This research will shed light on the disparities in treatment adherence among different racial and ethnic groups, including blacks and Hispanics.

“Medicare is a comprehensive medical insurance structure; people with Medicare typically don’t pay as much out of pocket as those with commercial private insurance plans. But even with that, some patients have trouble paying for their treatment,” says Sepassi. “Biologics are a mainstay therapy for rheumatoid arthritis and can be expensive. I wanted to know which Medicare beneficiaries are more vulnerable to cost-related medication abandonment.”

Approximately 2.0% of Medicare beneficiaries have RA, which translates to an estimated 1.3 million individuals aged 65 or older with the autoimmune disease. Medicare beneficiaries with RA bear twice the annual health care costs compared to those without the disease. A significant contribution to this cost comes from the biologics needed to treat moderate to severe disease. These Medicare patients pay an average of $23,544 per year compared to those not using biologics.

However, Medicare has different options and parts, which in turn have different out-of-pocket maximums. Until recently, Medicare Part B covered biologics administered at the doctor’s office or clinic, while Part D covered biologics that are self-administered. Since the Inflation Reduction Act (IRA) took effect, Part D no longer covers injected biologics and the Act enacted a “cap” of $2,000 on all Part D expenses. Patients now can also opt into the Medicare Prescription Payment Plan, which smooths out payments for Part D drugs over the year instead of having to pay all at once.

“To understand how this cap with Part D may affect affordability and adherence to RA biologics, we need to first understand how patients make decisions on these biologics without any caps in place,” says Sepassi. “Ideally, my proposed research can help identify who spent over $2,000 for their Part D medications, if any. These people would be the ones who would benefit the most from the IRA’s cap.”

Conversely, implementation of this limit can affect patient’s decision-making on biologics, she notes. For example, if more individuals of lower socioeconomic status rely more on Part B coverage for biologics than Part D, then Sepassi hypothesized that these individuals would now be more likely to adhere to their medications under Part D with the new cap.

For her research, Sepassi will investigate the differences between Black, Hispanic, Asian American, Pacific Islander and non-Hispanic white Medicare RA beneficiaries in their approach to biologic treatment. Specifically, she aims to better understand the proportion of patients who started office-administered biologics covered by Part B after abandoning self-administered biologics. The results of her research have the potential to shape future policies aimed at improving drug affordability and patient outcomes across different communities.

“I’m pleased to see that the Arthritis Foundation saw merit in my proposal,” says Sepassi. “I think this is an area of research that is needed, and as a new investigator, this award will give me the resources I need to jump-start this line of research that I hope to continue in the future.”