Barriers to Care

CreakyJointsPRO Studies Barriers to Care

One-third of rheumatoid arthritis (RA) patients with private insurance and nearly half of RA patients with Medicare coverage face barriers to their RA care. That’s the result of the first Patient-Reported Outcome survey conducted by CreakyJointsPRO.

What’s a “barrier to care”? Anything that stands in the way of a person receiving the RA treatment and medication he or she needs.

·         Are you unable to afford your RA medication? That’s a barrier to care.

·         Has your medication been switched to a different or cheaper drug by someone other than your rheumatologist? That’s a barrier to care.

·         Has your treatment schedule been delayed due to Medicare paperwork? That’s a barrier to care.

The Barriers to Care Study conducted by CreakyJoints in September 2013 was a simple survey designed to show the ways in which insurance coverage (or lack of it) affect an RA patient’s ability to treat and manage their RA. A total of 221 CreakyJoints participants completed the survey; they represent people in all regions of the United States and Puerto Rico.

Of RA patients with private insurance:

·         94.1 percent said they pay out-of-pocket expenses for their RA medication;

·         31.2 percent have very high co-pays or co-insurance;

·         28.8 percent reported having insufficient insurance coverage that led to claim denial;

·         26.5 percent have had their prescription medication switched by someone other than their rheumatologist;

·         23.4 percent pay for their own insurance.

Of those with Medicare coverage:

·         61.7 percent have had their insurance company or pharmacy benefit manager replace their brand name medication with a generic pain killer, NSAID, or methotrexate;

·         53.2 percent have had their prescriptions denied or switched to a cheaper drug by someone other than their rheumatologist;

·         48 percent covered by Medicare Part D have entered the coverage “Donut Hole” due to the cost of their medication;

·         46.9 percent have had their treatment delayed due to Medicare paperwork;

·         37 percent rely on some form of financial assistance—including family, friends, or charitable organizations—to pay for their RA medication.

Most troubling of all: almost 17.8 percent of those with Medicare coverage said they go without their medication when they enter the “Donut Hole” or if they have insufficient coverage on Medicare Part C.

How can these “barriers to care” be eliminated or mitigated? Co-pay cards might be one solution. Of those private insurance patients surveyed, 60 percent said they have used co-pay cards to pay for their medications and 75 percent said they would use a Smartphone app that provides coupons. Both privately insured and Medicare RA patients say that co-pay or coupon cards would motivate them to fill their prescriptions and stick with their treatments. (For a list of companies and organizations offering free and reduced-price arthritis medications, click here)

The CreakyJoints Barriers to Care Study was conducted by the Global Health Living Foundation (GHLF), the nonprofit umbrella organization for CreakyJoints and our 56,000 members nationwide.

Want to take part in the next CreakyJoints patient survey? Become a member of CreakyJoints!