Harmonization of Public Coverage Policies for Biologic Drugs in the Treatment of Rheumatoid Arthritis

The treatment of rheumatoid arthritis (RA) has improved considerably with the availability of specialty drugs and better disease management strategies. Although advances in therapy may have resulted in improved outcomes for some patients, the introduction of effective and often more costly drugs has resulted in increased public drug program spending. In light of budget constraints, public health care payers have implemented strategies for the use of these medications, including criteria for biologic disease-modifying antirheumatic drugs for eligible persons. However, these strategies have been applied differently across Canadian provinces and territories. This has resulted in differences in the public coverage and timing of access to biologic drugs for patients with RA across the country.

The purpose of this project is to determine whether common criteria may be identified and proposed to jurisdictions to align the access to biologic drugs across all publicly funded drug plans in Canada for patients with RA. As differences in access to these specialty drugs may impact health outcomes and program spending, the harmonization of public coverage policies may support the optimal management of patients with RA and ensure the sustainability of public drug programs.