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Improving care for patients with rheumatoid arthritis

08/26/2016

We're launching a program to improve the care of our Medicare members with rheumatoid arthritis (RA). Starting this month, we will examine Medicare claims for members who have been diagnosed with RA to see if they are receiving disease-modifying anti-rheumatic drugs (DMARDs).

The American College of Rheumatology recommends starting DMARD therapy within three months of diagnosis. Studies have shown that DMARDs control joint damage and prevent the disease from progressing aggressively.1

Members with RA who haven't been prescribed DMARDs will be contacted in writing and by phone and we will encourage them to talk to their doctors about the DMARD treatment. You may also get a call from our pharmacy representative to discuss your patient(s) and DMARD therapy.

If you are a primary care provider and are not comfortable initiating a DMARD therapy, we encourage you to refer patients to rheumatologists for a full evaluation.

A reminder about quality measures on RA
Medicare Advantage plans report RA metrics every year to the Centers for Medicare & Medicaid Services (CMS). The Medicare Star measure looks at how many of our members have been diagnosed with RA but have no pharmacy claims for DMARD.

1 2012 Update of the 2008 American College of Rheumatology Recommendations for the Use of Disease-Modifying Antirheumatic Drugs
and Biologic Agents in the Treatment of Rheumatoid Arthritis, Vol. 64, No. 5, May 2012, pp 625–639.