{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:03:09Z","timestamp":1790618589192,"version":"4.1.0"},"reference-count":39,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100014848","name":"Arnold Ventures","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014848","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We examine coverage of self\u2010administered disease\u2010modifying antirheumatic drugs (DMARDs) in Medicare Part D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using 2022\u20132026 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\u20106 (IL\u20106) 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 26,915 plan\u2010year observations, representing 217.6 million enrolled beneficiaries from 2022 to 2026. In the five\u2010year period, coverage was relatively complete (&gt;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\u20106 inhibitor), and baricitinib (JAK inhibitor). Moreover, only 10.4% and 37.6% of stand\u2010alone 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\u2010alone and MA Part D plans, respectively, covered abatacept. On the other hand, coverage increased for IL\u20106 inhibitors, likely due to the availability of biosimilar drugs for tocilizumab in 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The growing exclusions of self\u2010administered 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/art.70132","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T12:20:22Z","timestamp":1773750022000},"page":"2171-2178","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Coverage Generosity of Novel Antirheumatic Drugs in Medicare Advantage and Stand\u2010Alone Part D Plans"],"prefix":"10.1002","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8037-5758","authenticated-orcid":false,"given":"Youngmin","family":"Kwon","sequence":"first","affiliation":[{"name":"Department of Health Policy Vanderbilt University Medical Center  Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6787-9051","authenticated-orcid":false,"given":"Robert W.","family":"Corty","sequence":"additional","affiliation":[{"name":"Division of Rheumatology and Immunology, Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacie B.","family":"Dusetzina","sequence":"additional","affiliation":[{"name":"Department of Health Policy Vanderbilt University Medical Center  Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2019.25.8.879"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.24596"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2010.45"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.24560"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.39079"},{"key":"e_1_2_6_7_1","article-title":"Arthritis patients resort to an inconvenient Medicare workaround to avoid pricey drugs","author":"Howlett J","year":"2024","journal-title":"STAT"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/rap\/rky005"},{"key":"e_1_2_6_9_1","article-title":"A current snapshot of the Medicare Part D prescription drug benefit","author":"Cubanski J.","year":"2024","journal-title":"KFF"},{"key":"e_1_2_6_10_1","article-title":"Over half of Medicare Advantage beneficiaries enrolled in plans that require step therapy for new starts of Part B RA biologics in 2019","author":"Duddy\u2010Tenbrunsel R","year":"2019","journal-title":"Avalere Health"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.2147\/CEOR.S317687"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2023.29.6.607"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2024.01527"},{"key":"e_1_2_6_14_1","unstructured":"US Centers for Medicare and Medicaid Services.Quarterly prescription drug plan formulary pharmacy network and pricing information. May 22 2025. Accessed June 11 2025.https:\/\/data.cms.gov\/provider-summary-by-type-of-service\/medicare-part-d-prescribers\/quarterly-prescription-drug-plan-formulary-pharmacy-network-and-pricing-information"},{"key":"e_1_2_6_15_1","unstructured":"US Centers for Medicare and Medicaid Services.Formulary guidance. August 8 2025. Accessed August 21 2025.https:\/\/www.cms.gov\/medicare\/coverage\/prescription-drug-coverage\/formulary-guidance"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/amiajnl-2011-000116"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-145-6-200609190-00008"},{"key":"e_1_2_6_18_1","unstructured":"US Centers for Medicare and Medicaid Services.Medicare Advantage\/Part D contract and enrollment data. February 27 2025. 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Accessed June 30 2025.https:\/\/rarediseases.org\/medicare-ira-changes\/"},{"key":"e_1_2_6_27_1","unstructured":"NguyenA LiD.Being in the wrong Medicare Part D plan could cost over $800 per year. December 1 2022. Accessed July 1 2025.https:\/\/www.goodrx.com\/healthcare-access\/research\/medicare-part-d-unrealized-savings"},{"key":"e_1_2_6_28_1","article-title":"Nearly 7 in 10 Medicare beneficiaries did not compare plans during Medicare's open enrollment period","author":"Ochieng N","year":"2024","journal-title":"KFF"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/haschl\/qxae141"},{"key":"e_1_2_6_30_1","unstructured":"MarshT LiD.The big pinch: fewer medications covered more restrictions on covered drugs. June 26 2024. 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