A revolutionary blood test called PrismRA could potentially transform the way patients with rheumatoid arthritis are treated. The test, developed by Scipher Medicine, uses a predictive model that combines clinical factors, blood tests, and gene patterns to identify the approximately 60% of patients who are unlikely to respond to tumor necrosis factor inhibitors (TNFis), a common class of drugs used to treat rheumatoid arthritis. However, despite its potential to save patients time, money, and unnecessary pain, the widespread adoption of PrismRA faces obstacles, mainly from insurers and pharmacy benefit managers.
Rheumatoid arthritis patients often endure a long and painful journey of trying multiple drugs before finding one that provides relief. This frustrating process, compounded by the influence of middlemen in the drug market and insurers, contributes to patients cycling through different medications and experiencing unnecessary side effects. Currently, TNFis such as Humira are often the first prescription offered, even though they fail to significantly help around 50% of patients.
The lack of tools available for doctors to accurately predict which drug will work best for each patient exacerbates the problem. In many cases, it is the insurer rather than the healthcare provider who chooses the treatment, with insurers often opting for TNFis due to large rebates they receive from manufacturers. This practice has allowed AbbVie’s Humira to gain control over 98.5% of the adalimumab market in the United States.
The introduction of PrismRA could significantly improve the situation for rheumatoid arthritis patients. By identifying those who are unlikely to respond to TNFis, the test can help doctors make more informed treatment decisions. However, the test is rarely covered by insurance, making it inaccessible to many patients. The recent decision by the Centers for Medicare & Medicaid to start reimbursing for the test is a positive development, but more needs to be done to ensure its widespread use.
Precision medicine, which involves tailoring treatments to individual patients based on their unique biological pathways, is gaining traction in various fields of medicine, and rheumatoid arthritis should be no exception. With ongoing investments by academics, biotech companies, and pharmaceutical giants, advancements in diagnostics and treatment selection for autoimmune diseases are expected in the coming years.
The availability of tests like PrismRA could shorten the trial-and-error period for patients, providing relief and reducing anxiety and frustration. A survey conducted by the Global Healthy Living Foundation found that 91% of patients worry about their medications stopping working. It is crucial to address this concern and improve the chances of successful treatment outcomes.
The response of insurers to the availability of tests like PrismRA remains uncertain. The decreasing prices of TNFis due to the arrival of biosimilars could potentially make insurers less interested in adopting the test. However, there is evidence that the use of precision medicine tools can reduce TNFi prescriptions by up to a third. Some early trials have shown positive acceptance by insurers for alternative prescriptions based on the test results, suggesting a potential shift in their approach.
While the journey towards widespread implementation of precision medicine in rheumatoid arthritis treatment may still encounter obstacles, the potential benefits for patients and the healthcare system are significant. By optimizing drug selection and reducing unnecessary costs and side effects, tests like PrismRA have the potential to revolutionize the care of rheumatoid arthritis patients, provided that stakeholders embrace the power of precision medicine and prioritize the well-being of patients.
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it