Over the past year or two, plan sponsors have likely noticed drugs treating rheumatoid arthritis (RA) suddenly appearing in their listing of top therapeutic classes by cost for their paid drug claims. As RA is a leading cause of disability and can be a significant claims cost driver, it’s important to understand how RA impacts those who have been diagnosed with it and what employers can do to support positive health outcomes for their employees with this disease.

RA is a type of inflammatory arthritis and autoimmune disorder where, for reasons unknown, a person’s immune system attacks the synovium, or the tissue that lines the joints. This attack results in inflammation that, over time, can both destroy the synovium and erode the joint. RA is most commonly diagnosed between the ages of 25 and 50, with women affected three times more often than men. There is no cure for RA—the goal of treatment is to reduce the inflammation and push the disease into remission, slowing its progression.

Read: Impact of arthritis widespread

RA commonly affects the small joints of the hands and feet, and affected joints often occur on both sides of the body at the same time. Symptoms can include joint pain and stiffness, fatigue, lack of appetite and low-grade fever. Everyone experiences RA symptoms differently. One person may have symptoms well controlled with medication and supportive therapies, while another may experience frequent flares and severe inflammation.

RA is treated with prescription drugs in an effort to reduce the inflammation and interrupt or slow down the biologic processes causing the inflammation. DMARDs (disease-modifying anti-rheumatic drugs) are the primary drugs of choice in treating RA. They include drugs such Imuran, Arava and Methotrexate. DMARDs are often prescribed in combination with non-steroidal anti-inflammatories (NSAIDs), corticosteroids or other DMARDs. Biologics such as Remicade, Enbrel or Humira are also used to treat RA, sometimes in combination with a DMARD.

As with other chronic health conditions, people managing RA build a care team around them. For RA patients, this team would include a rheumatologist. It could also include a physiotherapist, occupational therapist, acupuncturist and/or massage therapist, nutritionist or naturopath, pharmacist and potentially a social worker or psychologist to help them with coping strategies for chronic pain. Some individuals with RA are also prescribed medical devices to help reduce joint load.

When the disease is active, or a person with RA is experiencing a “flare,” the symptoms can vary greatly over a seemingly short period of time. Flares can occur very suddenly even when the disease has been under control. Flares can fluctuate in duration, lasting days or months, in frequency and severity. When flares happen, rapid medical intervention can reduce both the severity and duration.

Read: Impact of arthritis widespread

Employees with RA may need some workplace accommodation to help ease their symptoms or work without pain. The degree to which modification is required is variable and depends on both their symptoms, which joints have active inflammation and their job duties: an administrator may have difficulty sitting for long periods, while a machinist may have challenges grasping objects. Employers can work with employees to make modifications to workspaces or provide adaptive tools to help with tasks such as typing or object manipulation. An assessment by an occupational therapist or ergonomist can help assess the impact of work tasks on any joint pain they may be experiencing. A flexible work arrangement can also be helpful—a schedule that allows for a later start in the morning or the ability to work from home can help an employee with RA to significantly improve productivity and task performance by working around morning joint pain and stiffness.

Employees managing their RA may have challenges scheduling medical appointments outside of work hours, especially when seeing specialists. While the RA is stable, most people see their rheumatologist every four to six months. Some medications require regular blood tests while they’re being taken or need to be administered in a hospital setting or infusion clinic. These appointments, including appointments with supportive practitioners such as physiotherapists or occupational therapists, for example, will increase in frequency during a flare. Make sure your employee is aware of your workplace’s policy about time off during the workday, and develop a plan for flexibility to accommodate appointments that must occur during peak business hours to set out a clear understanding of expectations ahead of time.

Most employers want to make sure employees have access to the drugs they need when they need them, while protecting their plans for the impact of high-cost drugs. As some drugs used to treat RA can be costly, employers can mitigate their risk by ensuring their plans are protected by pooling provisions and that their insurer has a robust prior authorization procedure in place. Prior authorization helps control costs by ensuring that other less costly treatments have been tried first and whether the more costly treatments will be beneficial. Employers should make sure their drug plans include a requirement for employees to participate in patient assistance plans when available for additional support. Some insurers also offer case management services for high-cost biologics to try to reduce waste while supporting better health outcomes for patients.

Read: Arthritis affects Canadians’ ability to work

Employers should take a critical look at potential barriers to treatment adherence in their plan design. High out-of-pocket costs can lead employees to choose not to fill prescriptions, leading to a more rapid progression of their disease and potential disability. Employers can also make sure that employees with RA have sufficient coverage for supportive therapies and assistive devices such as splints and mobility aids.

Disability policy language should also be reviewed: most disability policies are designed to address conditions that are somewhat sustained rather than chronic health conditions that can result in “pulses” of absence or disability. Depending on the provisions regarding recurrent disability, these episodic disabilities can result in barriers to benefit access and can slow attempts to return to work.

While challenges remain, there have been significant advances in the treatment of RA. With early treatment, good disease management once inflammation is under control and strong support from their employers, workers with RA can remain active and productive members of your workforce.

Kim Siddall is a vice-president and local practice leader at Aon. She has more than 20 years of experience in the health and benefits industry. These are the views of the author and not necessarily those of Benefits Canada.
Copyright © 2018 Transcontinental Media G.P. Originally published on benefitscanada.com

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See all comments Recent Comments

Charles Spina:

Terrific article. Clinically well informed, even though written by a non-clinician, and coupled with practical accommodation guidance for emplyers.

Tuesday, March 25 at 11:54 am | Reply

kaleem mohd:

Raise awareness of arthritis so everyone knows what support systems are available, including the employee benefits plan. Improved reimbursement of prescribed treatments on the extended benefits plans like Allied health professional services such as physiotherapy and occupational therapy help employees maintain physical and mental health, and to remain productive and part of the “corporate culture”.

Wednesday, March 09 at 3:13 am | Reply

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