2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T6e7,We examine coverage of self-administered disease-modifying antirheumatic drugs (DMARDs) in Medicare Part D. Using 2022-2026 Part D formulary data, we assessed coverage of the following DMARD classes that treat relapsed rheumatoid arthritis (RA): tumor necrosis factor (TNF) inhibitors, T cell costimulatory modulator, interleukin-6 (IL-6) inhibitors, and JAK inhibitors. We measured (1) coverage of individual DMARDs and (2) the generosity of coverage between classes (the share of plans covering at least one drug in each class) and within classes (the share of covered drugs within each class). We included 26,915 plan-year observations, representing 217.6 million enrolled beneficiaries from 2022 to 2026. In the five-year period, coverage was relatively complete (>94%) for etanercept and adalimumab (TNF inhibitors) and upadacitinib (JAK inhibitor). However, coverage was lower for golimumab and certolizumab (TNF inhibitors), abatacept (the sole T cell costimulatory modulator), sarilumab (IL-6 inhibitor), and baricitinib (JAK inhibitor). Moreover, only 10.4% and 37.6% of stand-alone and Medicare Advantage (MA) Part D plans, respectively, covered all mechanisms of action, mostly due to low coverage of abatacept. In 2026, only 0.3% and 21.2% of stand-alone and MA Part D plans, respectively, covered abatacept. On the other hand, coverage increased for IL-6 inhibitors, likely due to the availability of biosimilar drugs for tocilizumab in 2024. The growing exclusions of self-administered DMARDs across several mechanisms of action and heterogeneity in coverage by plan type suggest potential barriers to accessing optimal RA treatments. Further monitoring of formulary adequacy and research into the clinical impacts of formulary exclusions are warranted.31:T949, Objective We examine coverage of self‐administered disease‐modifying antirheumatic drugs (DMARDs) in Medicare Part D. Methods Using 2022–2026 Part D formulary data, we assessed coverage of the following DMARD classes that treat relapsed rheumatoid arthritis (RA): tumor necrosis factor (TNF) inhibitors, T cell costimulatory modulator, interleukin‐6 (IL‐6) inhibitors, and JAK inhibitors. We measured (1) coverage of individual DMARDs and (2) the generosity of coverage between classes (the share of plans covering at least one drug in each class) and within classes (the share of covered drugs within each class). Results We included 26,915 plan‐year observations, representing 217.6 million enrolled beneficiaries from 2022 to 2026. In the five‐year period, coverage was relatively complete (>94%) for etanercept and adalimumab (TNF inhibitors) and upadacitinib (JAK inhibitor). However, coverage was lower for golimumab and certolizumab (TNF inhibitors), abatacept (the sole T cell costimulatory modulator), sarilumab (IL‐6 inhibitor), and baricitinib (JAK inhibitor). Moreover, only 10.4% and 37.6% of stand‐alone and Medicare Advantage (MA) Part D plans, respectively, covered all mechanisms of action, mostly due to low coverage of abatacept. In 2026, only 0.3% and 21.2% of stand‐alone and MA Part D plans, respectively, covered abatacept. On the other hand, coverage increased for IL‐6 inhibitors, likely due to the availability of biosimilar drugs for tocilizumab in 2024. Conclusion The growing exclusions of self‐administered DMARDs across several mechanisms of action and heterogeneity in coverage by plan type suggest potential barriers to accessing optimal RA treatments. Further monitoring of formulary adequacy and research into the clinical impacts of formulary exclusions are warranted. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Biosimilar: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Biosimilar (modality). Clinician-written summaries and actionable practice insights. 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biosimilar brand names are not individually specified in the abstract.","value_numeric":null},{"paper_doi":"10.1001/jamaoncol.2026.3128","tag_type":"warning","value":"Pooled analysis across three biologics (bevacizumab, rituximab, trastuzumab) with different biosimilar entry dates may mask drug-specific trends.","value_numeric":null},{"paper_doi":"10.1001/jamaoncol.2026.3128","tag_type":"warning","value":"The paper is dated 2026; some referenced biosimilar entry timelines and pricing data may not yet be familiar to clinicians current as of mid-2026.","value_numeric":null}],"summaries":{"what_studied":"This retrospective cohort study examined market dynamics and financial implications of biosimilar entry for bevacizumab, rituximab, and trastuzumab among 14,655 patients in commercial and Medicare Part B insurance, using claims data from July 2019 to December 2024.","key_result":"Biosimilar-only use (59.4% of patients) was associated with $3,820 lower mean monthly payer costs and $39.50 lower mean monthly out-of-pocket costs vs. reference product-only use; reference product average sales price fell 3.8% annually and market share dropped ~30–31.5% per year after biosimilar entry.","limitations":"Retrospective claims-based design limits causal inference; data restricted to commercially insured and Medicare Part B patients, excluding Medicaid and uninsured; biosimilar entry timing differed across the three agents, complicating pooled trend analysis.","practice_takeaway":"Biosimilars for bevacizumab, rituximab, and trastuzumab meaningfully reduce costs for both payers and patients without evidence of compromised access. Clinicians and health systems should favor biosimilar initiation as the default to maximize affordability benefits."}},{"doi":"10.1002/art.70132","pmid":"41841636","title":"Coverage Generosity of Novel Antirheumatic Drugs in Medicare Advantage and Stand‐Alone Part D Plans","journal_title":"Arthritis & Rheumatology","journal_issn":"2326-5191","published_at":"2026-03-17T00:00:00.000Z","url":"https://doi.org/10.1002/art.70132","source_score":24,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-04-25","doi":"10.1002/art.70132","days":"30","issn":"2326-5191","rank":"7","field":"Clinical Medicine","score":"24","category":"Rheumatology","categories":["Rheumatology"],"_categories":["Rheumatology"]},"pubmed":{"doi":"10.1002/art.70132","title":"Coverage Generosity of Novel Antirheumatic Drugs in Medicare Advantage and Stand-Alone Part D Plans.","journal":"Arthritis & rheumatology (Hoboken, N.J.)","methods":"","results":"We included 26,915 plan-year observations, representing 217.6 million enrolled beneficiaries from 2022 to 2026. In the five-year period, coverage was relatively complete (>94%) for etanercept and adalimumab (TNF inhibitors) and upadacitinib (JAK inhibitor). However, coverage was lower for golimumab and certolizumab (TNF inhibitors), abatacept (the sole T cell costimulatory modulator), sarilumab (IL-6 inhibitor), and baricitinib (JAK inhibitor). Moreover, only 10.4% and 37.6% of stand-alone and Medicare Advantage (MA) Part D plans, respectively, covered all mechanisms of action, mostly due to low coverage of abatacept. In 2026, only 0.3% and 21.2% of stand-alone and MA Part D plans, respectively, covered abatacept. On the other hand, coverage increased for IL-6 inhibitors, likely due to the availability of biosimilar drugs for tocilizumab in 2024.","abstract":"$30","keywords":[],"pubmed_id":"41841636","conclusions":"The growing exclusions of self-administered DMARDs across several mechanisms of action and heterogeneity in coverage by plan type suggest potential barriers to accessing optimal RA treatments. Further monitoring of formulary adequacy and research into the clinical impacts of formulary exclusions are warranted.","publication_date":"2026-03-17T00:00:00"},"crossref":{"DOI":"10.1002/art.70132","URL":"https://doi.org/10.1002/art.70132","ISSN":["2326-5191","2326-5205"],"link":[{"URL":"https://acrjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/art.70132","content-type":"application/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https://acrjournals.onlinelibrary.wiley.com/doi/full-xml/10.1002/art.70132","content-type":"application/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://acrjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/art.70132","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Coverage Generosity of Novel Antirheumatic Drugs in Medicare Advantage and Stand‐Alone Part D 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Accessed November 23 2024.https://maprx.info/wp-content/uploads/2024/08/MAPRx_whitepaper_2024-08-15_Final.pdf","article-title":null,"journal-title":null,"doi-asserted-by":null},{"DOI":null,"key":"e_1_2_6_39_1","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"EVERSANA.Special Report: Inflation Reduction Act sets Part D stakeholders scrambling. September 28 2022. Accessed June 28 2025.https://www.eversana.com/2022/09/28/special-report-inflation-reduction-act-sets-part-d-stakeholders-scrambling/","article-title":null,"journal-title":null,"doi-asserted-by":null},{"DOI":null,"key":"e_1_2_6_40_1","year":"2019","issue":null,"author":"Lampner C.","volume":null,"first-page":null,"unstructured":null,"article-title":"Switch or swap: strategies for anti‐TNF failure in rheumatoid arthritis","journal-title":"Rheumatology Advisor.","doi-asserted-by":null}],"short-title":[],"update-policy":"https://doi.org/10.1002/crossmark_policy","alternative-id":["10.1002/art.70132"],"article-number":"art.70132","content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"original-title":[],"container-title":["Arthritis & Rheumatology"],"reference-count":39,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,4,20]]},"references-count":39,"short-container-title":["Arthritis & Rheumatology"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1002/art.70132","is_oa":true,"title":"Coverage Generosity of Novel Antirheumatic Drugs in Medicare Advantage and Stand‐Alone Part D Plans","updated":"2026-04-21T12:05:45+00:00","published_date":"2026-03-17","best_oa_location":{"url":"https://doi.org/10.1002/art.70132","pmh_id":null,"url_for_pdf":null,"url_for_landing_page":"https://doi.org/10.1002/art.70132"}}},"created_at":"2026-05-07T22:49:27.383Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1002/art.70132","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"brand","value":"Actemra","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"brand","value":"Cimzia","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"brand","value":"Enbrel","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"brand","value":"Humira","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"brand","value":"Kevzara","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"brand","value":"Olumiant","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"brand","value":"Orencia","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"brand","value":"Rinvoq","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"brand","value":"Simponi","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"category","value":"Rheumatology","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"condition","value":"Rheumatoid Arthritis","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"generic","value":"abatacept","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"generic","value":"adalimumab","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"generic","value":"baricitinib","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"generic","value":"certolizumab","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"generic","value":"etanercept","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"generic","value":"golimumab","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"generic","value":"sarilumab","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"generic","value":"tocilizumab","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"generic","value":"upadacitinib","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"modality","value":"Biosimilar","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"modality","value":"IL-6 Inhibitor","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"modality","value":"JAK Inhibitor","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"modality","value":"T Cell Costimulatory Modulator","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"modality","value":"TNF Inhibitor","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"sample_size","value":"n=26,915 plan-year observations","value_numeric":26915},{"paper_doi":"10.1002/art.70132","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"study_design","value":"Cross-Sectional Study","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"warning","value":"Sample size reflects plan-year observations (n=26,915), not individual patients; the 217.6 million figure represents cumulative enrolled beneficiaries across plan-years and should not be interpreted as unique patients.","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"warning","value":"Study design is best characterized as a repeated cross-sectional analysis of administrative formulary data; no causal inference about patient outcomes is possible.","value_numeric":null},{"paper_doi":"10.1002/art.70132","tag_type":"warning","value":"The 'safety_signal' impact flag is applied here in the access/policy sense — formulary exclusions represent a barrier to care signal, not a drug safety signal in the traditional adverse-event sense.","value_numeric":null}],"summaries":{"what_studied":"Coverage generosity of self-administered DMARDs (TNF inhibitors, T cell costimulatory modulator, IL-6 inhibitors, JAK inhibitors) across Medicare Part D stand-alone and Medicare Advantage plans from 2022–2026, using 26,915 plan-year observations representing 217.6 million enrolled beneficiaries.","key_result":"Coverage exceeded 94% for etanercept, adalimumab, and upadacitinib, but was markedly lower for abatacept (only 0.3% of stand-alone and 21.2% of MA Part D plans covered it in 2026). Only 10.4% of stand-alone and 37.6% of MA plans covered all mechanisms of action. IL-6 inhibitor coverage improved after tocilizumab biosimilars launched in 2024.","limitations":"Formulary data reflect plan-level coverage but do not capture actual patient-level access, utilization, or clinical outcomes resulting from exclusions. The study period ends at 2026, so long-term trends cannot be assessed. Reasons behind specific formulary exclusion decisions (e.g., rebate negotiations) are not examined.","practice_takeaway":"Clinicians prescribing abatacept or less-covered DMARDs to Medicare patients should proactively verify formulary status, as coverage varies widely by plan type and has been declining. Awareness of biosimilar-driven coverage gains (e.g., tocilizumab biosimilars) may help identify accessible alternatives when preferred agents are excluded."}}],"initialOffset":2,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Biosimilar"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Biosimilar"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Biosimilar"}}}]]

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