Healio Rheumatology, November 2017
Clinicians who treat patients with rheumatologic diseases are facing an ever-growing set of non-clinical challenges. The issue at hand is managed care, and the crux of the problem is that the U.S. health care system has grown increasingly cumbersome and complex, forcing clinicians to spend more time dealing with bureaucracy and less time working toward patient outcomes. Moreover, some experts believe it to be problematic that the profit-driven structure of the U.S. health care system has increased the number of non-clinical and non-medical players involved. For example, pharmacy benefit managers initially filled the role of translator in a complex pay structure system, taking some administrative work away from clinicians and helping them focus on patients. However, their role in the system has increased, often without being sufficiently or clearly defined.
Non-medical switching of therapies is another concern for physicians, with payers forcing physicians to make clinical decisions they might not have otherwise made. Drug costs are increasing. Biosimilar therapies, though effective, face an uphill battle in the approval process in the United States.