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TOPLINE:

Patients with giant cell arteritis started tocilizumab therapy an average of 43 days after diagnosis, partly because of delays in insurance approval.

METHODOLOGY:

• Overall, 82 patients (average age, 73 years; 60% women; 87% White individuals) newly diagnosed with giant cell arteritis at the University of Washington, Seattle, between November 2017 and August 2024 were prescribed 162 mg of subcutaneous tocilizumab.
• Data on demographics, insurance type, and detailed timelines for medication request, approval, and initiation were collected.
• When available, cost data for tocilizumab were obtained from insurance quotes, along with information on prior authorization requirements, copay assistance, and medication coverage.
• The time from the initial tocilizumab request to insurance approval and medication start was analyzed, and costs by insurance payer were compared.

TAKEAWAY:

• Delays in approval for and administration of tocilizumab therapy for newly diagnosed giant cell arteritis increase the risk for vision loss, glucocorticoid exposure, and side effects.
• The average time from tocilizumab request to the start of treatment was 43 days; from request to insurance approval, 17 days; and from approval to medication start, 30 days.
• Out-of-pocket costs for tocilizumab averaged $1399 for Medicare patients, $823 for those with Medicare Advantage, $211 for those with commercial insurance, and $0 for Medicaid (P < .01).
• Commercially insured patients used copay cards more often than other payers (P < .01); Medicare or Medicare Advantage patients had a higher utilization of medication coverage from drug manufacturers (P = .04).

IN PRACTICE:

“During the study period, there was only one FDA-approved medication for GCA [giant cell arteritis], yet the high cost and delays to medication start remained high. Understanding the delays, costs, and factors that prevent timely therapy is critical to rheumatologic and geriatric care,” the authors of the study wrote.

“[T]he results offer important insights into the administrative and financial frustrations related to securing biologic approval and coverage, which has been documented in other conditions,” experts wrote in an editorial.

SOURCE:

This study was led by Dominique Feterman Jimenez, MD, University of Washington. It was published online on March 15, 2025, in The Journal of Rheumatology.

LIMITATIONS:

The single-center design may limit the generalizability of the findings beyond Washington State because insurance plans vary by state. The predominance of patients with Medicare may also limit applicability of the findings. The small sample size restricted the ability to analyze differences among various Medicare supplemental plans.

DISCLOSURES:

One author disclosed receiving support from a Rheumatology Research Foundation Investigator Award. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.