Coverage Generosity of Novel Antirheumatic Drugs in Medicare Advantage and Stand‐Alone Part D Plans
Authors' 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.
Study context
- Population
- Medicare Part D plans, 2022–2026; coverage of self-administered disease-modifying antirheumatic drugs (DMARDs) for relapsed rheumatoid arthritis (RA) (TNFi, T cell costimulatory modulator, IL-6 inhibitors, JAKi)
- Participants
- 26,915 plan-year observations
- Exposure
- Stand-alone Part D plans vs Medicare Advantage (MA) Part D plans
- Outcome
- Coverage of individual DMARDs and generosity of coverage between and within classes
Methodological detailsPart D formulary data 2022-2026, 217.6 million enrolled beneficiaries represented
- Part D formulary data 2022-2026
- 217.6 million enrolled beneficiaries represented
Main finding
As reported in the abstract
Plans covering all mechanisms of action
- Coverage relatively complete for etanercept, adalimumab and upadacitinib
- >94%
Observational data: associations, not effects.
Further findings
Plans covering abatacept · 2026
Coverage of IL-6 inhibitors
- Coverage increased, likely due to tocilizumab biosimilars available in 2024
Original publication
Coverage Generosity of Novel Antirheumatic Drugs in Medicare Advantage and Stand‐Alone Part D Plans. Arthritis Rheumatol. Published 20 April 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →