Cost of Rheumatoid Arthritis: Drugs, Tests, Assistance - Verywell Health

Rheumatoid arthritis (RA) is classified as both an autoimmune and inflammatory disease, which means it happens when the immune system attacks healthy cells and leads to swelling and pain in the body. It is a long-term condition with symptoms that include swollen, painful, and stiff joints, as well as general fatigue and weakness.

This condition can be difficult and expensive to treat, especially with certain types of medications that are costly to produce. People with RA face an average of $12,500 in medical expenses per year and over $36,000 for people who take biologic medications to slow the progression of the disease.

This article will provide an overview of RA treatment options, medications, and how to afford the costs.

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What Makes RA Expensive to Treat?

A type of specialty medication called biologic disease-modifying antirheumatic drugs, or bDMARDs, is the most expensive rheumatoid arthritis treatment. This treatment option is sometimes referred to as biologics or biological medications.

They can cost $25,000–$40,000 per year. Biologics are expensive to produce because they are made using living organisms and the process to make them is complicated, so this increases the cost of production.

With Insurance

While insurance plans do cover RA treatments, including biologics, they do not always cover the full amount. For example, Medicare Part D Patients pay an average of $835 per month for biologics. This is a big challenge because one-third of people with RA become disabled and are unable to work. Also, the more severe cases tend to respond to biologics but not to other treatment options.

Without Insurance

Paying for RA treatment can be even more of a challenge for people without insurance. Many of these people are unable to afford biologics and opt for lower-cost options instead. However, there are financial assistance options to help people pay for biologics. For example, the company that makes Enbrel (etanercept), a biologic option for RA, offers financial support to temporarily lower the cost of the medication to as low as $5 per month for some people.

Estimated RA Costs

Medication expenses are a big part of the total costs people with RA face, but there are more. There are also costs for medical care such as healthcare provider and hospital visits, testing, and more. People with RA, on average, pay about $12,500 per year in medical expenses. This estimate does not include indirect costs of RA such as missed time from work, so the true cost of the disease is even higher.

Provider/Hospital Visits

People with rheumatoid arthritis may need to make regular visits to healthcare professionals, including primary care practitioners and specialists, to manage care and medication prescriptions. The average out-of-pocket cost, including insurance co-payments, for one office visit with a specialist, such as a rheumatologist who treats rheumatoid arthritis, is nearly $100.

In some cases, such as serious medication reactions, people with RA may need to go to a hospital emergency room (ER) for care. The average cost of an ER visit is $2,200.

Testing

There is not one specific test to diagnose rheumatoid arthritis. Instead, healthcare professionals combine a physical examination with multiple tests to determine a diagnosis.

Tests that may be used to diagnose RA include:

The costs of these tests can add up, and there may be additional charges for appointments to be tested and then to go over the results. Additionally, it is not always clear how much the tests will cost before getting them.

Medication

Medications for RA include:

• bDMARDs can cost over $2,400 per month, depending on the specific medication and dose.
• DMARDs can cost over $500 per month, depending on the specific medication and dose.
• Janus kinase (JAK) inhibitors can cost over $3,600 per month, depending on the specific medication and dose.
• Pain-relief medications are medications such as acetaminophen and codeine, and while they are some of the least expensive options, they are generally not effective for RA and are not recommended.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) can cost up to $300 per month, depending on the specific medication and dose.
• Corticosteroids, or steroids, can cost up to $55 per month, depending on the specific medication and dose.

Therapy

In addition to healthcare provider and hospital visits, testing, and medications, people with RA may also have therapy treatments. There are costs for these visits as well, and the out-of-pocket amounts vary depending on the specialist, treatment protocol, and insurance coverage.

Therapy for RA may include:

Surgery may also be an option for RA treatment, but this is rare, and patient costs can vary greatly depending on what is needed and insurance coverage.

Indirect Cost of Missed Work

When considering the cost of RA, most calculations include medical costs only and not the indirect costs such as lost time from work, fees paid to caregivers, and other expenses related to RA.

Compared to people without RA, people with RA miss more days of work and lose an average of nearly $600 more per year. Additionally, people with RA may be less productive at work due to their symptoms, which can result in lower pay.

Financial Assistance for RA Treatment

People with RA may be eligible for financial assistance to help with costs. This may be an option for people with and without insurance.

Some possible options for RA financial assistance include:

Setting Up a Flexible Spending Account

A flexible spending account (FSA), or flexible spending arrangement, is like a bank account for healthcare expenses. The benefits of this type of account are that taxes are not paid on money put into the account and some employers add to the account. However, it requires having a healthcare plan from an employer.

The money in an FSA can only be used for specific healthcare expenses, and there are limits to the amount of money that can be allocated to the account each year. Anyone considering an FSA can contact their employer to get started.

Generic Medication List

Generic medications may be a cost-savings alternative to brand-name medications. They are generally cheaper than the brand-name options because another company has already funded the research, development, and testing of the medication for safety and effectiveness.

Some generic medications used to treat RA include:

Other Cost-Saving Measures

In addition to financial assistance programs, flexible spending accounts, and generic medications, there are things people with RA can do to save on expenses. Contacting the healthcare provider's office for help is a good option because they could be aware of more affordable alternatives or additional assistance. Supplemental insurance can help lower costs, as well.

People with rheumatoid arthritis are protected under the Affordable Care Act and can shop for the best plan for them. There are laws to protect against the indirect cost of missing work, too.

Employers are required to make reasonable accommodations for people with disabilities. It may be helpful to talk with employers about flexible hours, remote work options, or other provisions.

Summary

Rheumatoid arthritis is a long-term medical condition that involves painful, swollen joints and fatigue. The symptoms can be severe enough to interfere with daily life. This condition can be expensive to treat, with the costs of medical visits, testing, and medications factoring in. Additionally, people with RA may miss work due to symptoms, or be disabled to the point of not being able to work at all.

There are things people with RA can do to overcome the financial challenges of the disease. For example, there are financial assistance programs and generic medications that can lower the cost of treatment. FSAs can help pay for healthcare expenses. There are laws to protect people with RA, which help with insurance coverage and accommodations at work.

A Word From Verywell

Suspecting, being diagnosed with, and living with rheumatoid arthritis can be challenging, especially when symptoms are severe enough to interfere with daily life. The financial burden can be an extra challenge.

If you or someone you know is experiencing rheumatoid arthritis, reach out to a healthcare professional such as a primary care practitioner or rheumatologist for support. It is possible to receive financial support and treatment to improve your symptoms.

Frequently Asked Questions

• Biologic drugs do tend to be more expensive than other medications and treatment options for rheumatoid arthritis. They can cost over $500,000 per year and the average cost is $10,000 to $30,000 per year. This is because the things used to make them, and the process of making them, are complex and more expensive compared to other medications.

• To help with the high cost of treatment for rheumatoid arthritis, there are organizations that offer assistance. These options include the Patient Access Network Foundation for Medicare patients, Rx Outreach, and The Assistance Fund.

• Marketplace insurance does cover rheumatoid arthritis and there are laws to protect people with RA so they get coverage. However, that does not mean all medications are covered, or that the medication options that are covered are covered enough for them to be affordable for everyone.