Based on the popularity of our previous analyses, we extended the review of biologic agents to rheumatoid arthritis (RA). The latest
treatment guidelines in this therapeutic area were issued by the American College of Rheumatology (ACR) in 2008. According to these guidelines, TNF-antagonists (Enbrel, Humira, Remicade) are recommended interchangeably in the following patients with RA:
•As first-line therapy in patients with early RA and high disease activity
•As second-line therapy (after MTX) in patients with intermediate/longer-acting RA and high disease activity or moderate disease activity in the presence of features of poor prognosis
•As third-line therapy (after MTX combo or sequential DMARDs) in patients with intermediate/longer-acting RA and moderate to high disease activity
Orencia and Rituxan are recommended as third-line therapy (after MTX combo or sequential DMARDs) in patients with intermediate/longer-acting RA and moderate to high disease activity in the presence of features of poor prognosis. Combinations of biologic agents was not recommended.
In an analysis of 6 regional and national plans, most plans use “failure of at least 1 DMARD” in their criteria for TNF-antagonists, and Orencia and Rituxan are more likely to be reserved after failure of a TNF antagonist. Additionally 5/6 plans institute quantity limits of these agents.
The following figure provides a comparative summary of the selected policies (click on the image to enlarge it).
Sources:
Blue Cross and Blue Shield of Florida. Medical coverage guidelines
The Regence Group. Enbrel policy
The Regence Group. Humira policy
The Regence Group. Orencia policy
The Regence Group. Remicade policy
BlueCross BlueShield of Alabama. Enbrel coverage criteria
BlueCross BlueShield of Alabama. Humira coverage criteria
BlueCross BlueShield of Alabama. TNF Antagonists and Other Biologics for Rheumatologic Diseases: Remicade policy
Wellpoint, NextRx. Enbrel policy
Wellpoint, NextRx. Orencia policy
Wellpoint, NextRx. Humira policy
Wellpoint, NextRx. Remicade policy
Atena. Clinical Policy Bulletin: Enbrel
Aetna. Clinical Policy Bulletin: Humira
Aetna. Clinical Policy Bulletin: Orencia
Aetna. Clinical Policy Bulletin: Remicade
Aetna. Clinical Policy Bulletin: Rituxan
Cigna. Enbrel Coverage Position
Cigna. Humira Coverage Position
Cigna Orencia Coverage Position
Cigna. Remicade Coverage Position
Cigna. Rituxan Coverage Position