Utilization Patterns of Disease-Modifying Antirheumatic Drugs for the Treatment of Rheumatoid Arthritis: Rationale for Improving the Harmonization of Coverage Criteria

Executive Summary
Background/Issue: Rheumatoid arthritis (RA) is a chronic and debilitating disease associated with significant comorbidities and higher risk of mortality for Canadians, with a prevalence of approximately 1.2% of adults living with RA. The first line of treatment for RA is usually conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), but for patients with inadequate response to csDMARDs, the next phase of therapy is typically biologic disease-modifying antirheumatic drugs (bDMARDs). The use of these medications in the treatment of RA is likely to differ across public drug plans because of variations in prescribing patterns and coverage criteria.

Objective: This analysis examined utilization patterns of csDMARDs and bDMARDs for the treatment of RA across public drug plans in Canada over the past several years to identify the rationale for improving coverage criteria harmonization.

Approach: Claims data related to the treatment of RA were extracted for all provincial drug plans (except Quebec) and Yukon from 2015 to 2020 and a descriptive analysis was performed to assess the utilization patterns of csDMARDs, the time to initiate bDMARDs, and the utilization patterns of bDMARDs. The proportion and number of csDMARDs used, the mean time from the initiation of csDMARDs to the initiation of bDMARDs, the persistence of utilization of bDMARDs 6 months after initiation, the changes in proportion and cost per patient of bDMARDs, and the uptake of biosimilars were assessed.

Implications for Policy-Makers: These findings provide a rationale for the harmonization of coverage criteria and reimbursement processes for public drug plans; coverage criteria for csDMARDs can be harmonized to include 3 lines of therapy for all jurisdictions. This could provide modest cost savings to some jurisdictions without impacting health outcomes. Costs per patient for bDMARDs can be reduced through greater uptake of biosimilars and implementation of formulary management strategies such as tiering frameworks (e.g., as in Manitoba).

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