Will Medicare stand in the way of innovative rheumatoid arthritis treatment? | Column
“We must work tirelessly to support policies that positively impact rheumatoid arthritis patients and practices.”
An x-ray of an arthritic hand.
An x-ray of an arthritic hand. [ COURTESY IMAGES FROM USF HEALTH | USF Health/Times files ]
Published Feb. 25|Updated Feb. 27

Rheumatoid arthritis is an autoimmune disease that affects millions of Americans, causing pain, stiffness, and swelling in the joints. If left inadequately treated, rheumatoid arthritis can cause serious joint damage. Early diagnosis is critical and can improve a patient’s prognosis, reduce long-term disability, and improve quality of life.

Dr. Priya Reddy
Dr. Priya Reddy [ Courtesy of Dr. Priya Reddy ]

While there have been many advances in drugs that can treat this debilitating condition in recent decades, there have been relatively few corresponding advances in the science of determining which one of the multiple options available to rheumatoid arthritis patients will or will not work for them. One such breakthrough in the field of precision medicine, a diagnostic test that could help get patients to the right therapy far more quickly than before, is seeing widespread use in the private market, but Florida’s 4.5 million Medicare beneficiaries are unlikely to have access to this new technology unless action is taken.

Treatment options for rheumatoid arthritis vary depending on the severity of the disease, ranging from medications, physical therapy, occupational therapy, or surgery. Given the vast range of treatments necessary to manage RA and the high costs associated with its care, it is incredibly helpful to provide patients with access to precision medicine – also known as personalized care plans.

The precision medicine test that recently became available, called PrismRA, works by predicting patient non-response to tumor necrosis factor inhibitor (TNFi) therapies which are the most frequently prescribed class of advanced rheumatoid arthritis medications, especially as the first-choice drug. Multiple studies have demonstrated that only one-in-three patients will adequately respond to TNFi therapy, making a pre-prescription diagnostic test even more important to early, effective treatment and a patient’s long-term outlook.

Here in Florida, we must work tirelessly to support policies that positively impact rheumatoid arthritis patients and practices, particularly among the millions of Medicare beneficiaries who live in the state. The try-and-fail approach for finding the right therapy for an individual patient, which is unfortunately the status quo, is far from ideal for anyone involved. Patients may go months without effective therapy for their condition, or our strained healthcare system, which pays for potentially ineffective treatments and the long-term health consequences of the unchecked disease.

Predictive testing will provide healthcare professionals with the ability to select the best treatment option for patients based on scientific data, significantly reduce the need to rely on try-and-fail regimes and get patients on the right drug more rapidly. And by covering tests like this for rheumatoid arthritis, Medicare can help to ensure that patients get the care they need to manage their condition and live long, healthy and productive lives.

Protecting patients’ access to appropriate rheumatologic medical care is crucial and should be made a top priority, especially considering last year’s troubling, preliminary ruling stating that Medicare beneficiaries will not have coverage for this innovative diagnostic tool without intervention by policymakers. This will effectively force patients to stick with the try-and-fail method, meaning that two-thirds of patients who don’t respond adequately to TNFi therapies will waste precious time and money searching for the right treatment while their disease progresses or their quality-of-life declines.

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Members of Florida’s congressional delegation must work together with their colleagues on both sides of the aisle to establish policies to protect rheumatoid arthritis patients and ensure that Medicare beneficiaries are covered and provided with access to precision medicine, starting with this predictive test.

Dr. Priya Reddy is a practicing rheumatologist at AARA-Southwest Florida Rheumatology, based in the Tampa Bay area. She is the president elect of the Florida Society of Rheumatology, a fellow of the American College of Rheumatology and a member in good standing with the American Medical Association, American College of Physicians, Florida Medical Association and Hillsborough County Medical Association.