Step therapy is a utilization management strategy used by third-party payers to reduce the cost of prescription drug utilization. Essentially, it establishes a hierarchy or protocol of preferred agents for a specific medical condition, such as rheumatoid arthritis (RA). Patients and prescribing healthcare providers are required to first attempt these preferred treatments before gaining access to second and third-line options.
“The intention behind this is to guide patients and providers toward more cost-effective medications, ideally saving money within the healthcare system,” Boone, a rheumatologist at Rheumatology Associates, PLLC, explained. “However, there's ongoing debate about whether this approach actually leads to long-term cost savings within the broader healthcare system.”
In an interview with HCPLive Rheumatology, Boone, discusses his recent research, “Confronting Step Therapy in Rheumatoid Arthritis: A Rheumatology Practice’s Experience Using PrismRA to Bypass Ineffective TNF Inhibitor Therapies.”
PrismRA, a one-time blood test designed to introduce personalized medicine into the management of RA, can help patients avoid ineffective tumor necrosis factor (TNF) inhibitor treatments. It assesses 23 personalized features for each patient, composed of 19 RNA transcripts, 1 serologic feature, and 3 additional clinical features.
Using an artificial intelligence algorithm, PrismRA predicts whether a patient is likely to have an inadequate response to a TNF inhibitor, defined as the failure to achieve an American College of Rheumatology 50% response (ACR50) improvement after 6 months of treatment.
“This innovative tool provides rheumatologists with the ability to predict, with high confidence, whether the TNF inhibitor class is suitable for an individual patient,” Boone said. “If PrismRA predicts an inadequate response, we can opt for alternative mechanisms of action, selecting from other targeted DMARDs that are likely to be more effective for that particular patient.”
However, one of the primary concerns Boone has regarding personalized medicine tools like PrismRA is whether third-party payers will approve the treatment suggested by these predictive tools.
“Personalized medicine can only be effective if we can access the treatments recommended by these predictive tools,” he stressed. “Therefore, the greatest challenge in implementing PrismRA has been navigating situations where the test predicts an inadequate response to TNF inhibitors. The question becomes whether we can secure a non-TNF inhibitor treatment or if we're still compelled to use a TNF inhibitor even when PrismRA suggests it may not be the best approach for that particular patient.”
This transcript was edited for clarity.
Disclosures: Dr Boone’s latest step therapy research was funded with help from Schiper Medicine.