SLE – Lupus: Size of Copay Influences Medication Adherence Interview with:
Raisa Silva, M.D.
Resident physician in Internal medicine
University of Pittsburgh Medical Center What is the background for this study?

Response: Systemic lupus erythematosus (lupus for short) is a complex disease that significantly affects patients’ lives. Adherence to medications for lupus is known to be suboptimal (it can be as low as 15% in some studies). Multiple social factors may affect treatment adherence. For example, costs of medications (including copayments, deductibles, co-sharing), polypharmacy (patients with lupus often have comorbid diseases that also need medications), and potential side effects are some of the reasons why patients may have difficulty in taking medications for lupus every day. The costs of insurance copayment may represent a major obstacle to adherence. The lack of adherence to lupus medications is associated with poor control of disease, more symptoms, and worse disease outcomes, such as more hospitalizations and more severe disease.

In our study, we examined the association between lupus medications copayment and adherence to these medications (some of the most commonly used medications for lupus). What are the main findings?

Response:  Our results showed that copayments of $10 or more are associated with decreased adherence to medications, and this finding is independent of patients’ comorbidities, household income, educational level, among other factors. In a database of 12510 individuals with lupus, the adherence to hydroxychloroquine, azathioprine, and mycophenolate mofetil was 39%, 52%, and 32% lower, respectively, for copayments equal to or above $10. Even seemingly minor increases in copayments had an effect on patients’ adherence to these medications, which can impact their care and their health. What should readers take away from your report?

Response: The impact of copayments may significantly affect patients’ treatment and control of their disease (such as lupus). We should all take copayment into consideration when discussing medication options for our patients. While establishing copayments could theoretically reduce health care costs, it could worsen patients’ diseases and outcomes, and that can potentially increase health care utilization and costs overall, as patients with poor disease control will visit the Emergency Department more often and will be admitted to the hospital more frequently as well. They will also likely need more care overall, such as specialists’ office visits, treatments, etc. Patients’ health should be the first priority in our health care system, and finding a pathway to decreasing medication costs, and improving medication access equity should be our goal. What recommendations do you have for future research as a results of this study?

Response: There is much to be done in terms of further researching how health care costs affect patients’ lives and how we can strive to improve care and access for our patients. Research could be done assessing how, specifically, medication cost is affecting patients with lupus – are they using more corticosteroids because their disease is not controlled? Are they having more severe renal disease? We believe that a reduction in copayment would potentially increase adherence, improve outcomes, and reduce overall costs. Research assessing how copayment affects different groups differently is among our near-future goals (e.g. different ethnic and racial groups, groups in different economic stratum, etc). We could also examine how and if it would be possible to include medication costs in guidelines for the treatment of chronic illnesses, such as lupus. Is there anything else you would like to add? Any disclosures?

Response: As medicine and research advances, over the last years we have had a world of new therapeutic options for patients with rheumatological illnesses. Biological drugs, small molecule inhibitors targeting inflammatory cytokines and intracellular kinases, monoclonal antibodies are all treatments that have revolutionized the treatment of autoimmune diseases. There is a phenomenal myriad of research trials ongoing that promise to improve these patients’ quality of life.

However, we need to prioritize access to these (and other) medications – advancements in medicine are only worthwhile when they are accessible to patients. Studying the impact of costs to patients’ lives is essential, as we can only change what we are able to measure.

We have no financial disclosures related to this work.


Abstract: 1115 • Presented at ACR Convergence 2022
Medication Co-pay Modifies Treatment Adherence in Patients with Systemic Lupus Erythematosus

Raisa Lomanto Silva1, Gretchen M Swabe2 and Jared W Magnani31University of Pittsburgh Medical Center, Pittsburgh, PA, 2Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 3Heart and Vascular Institute, University of Pittsburgh Medical Center; Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, PA

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Last Updated on December 1, 2022 by Marie Benz MD FAAD