Ask The Pharmacist: Cosentyx and Its Place in Workers’ Comp
Jonathan Rowell, Pharm. D.
Clinical Pharmacist, Pharmacy Solutions
Could Cosentyx serve as an effective treatment option for chronic autoimmune conditions within workers’ compensation?
Are you seeing requests for Cosentyx for your injured employee but are unclear on the application of this medication? Cosentyx, a biologic medication developed by Novartis, is increasingly recognized in the treatment landscape for chronic autoimmune conditions such as plaque psoriasis, ankylosing spondylitis and psoriatic arthritis. Classified as an interleukin-17A (IL-17A) inhibitor, Cosentyx selectively binds to IL-17A. By blocking IL-17A, which plays a role in promoting inflammation within the immune system, Cosentyx reduces inflammation and helps manage autoimmune diseases characterized by overactive IL-17A pathways.
This targeted approach is beneficial for conditions that involve chronic joint pain, skin lesions and inflammation which can severely affect an individual’s ability to work. For employees who suffer from these conditions, treatment can result in significant symptom relief, potentially preventing long-term disability claims. Cosentyx’s role in workers’ compensation is primarily tied to its application for musculoskeletal and autoimmune conditions that lead to workplace injuries or exacerbated health issues. Employees in physically demanding jobs, such as construction or manufacturing, are particularly susceptible to conditions like psoriatic arthritis and ankylosing spondylitis, which can severely limit mobility, strength and endurance, often leading to extended absences from work.
In cases where traditional treatments such as non-steroidal anti-inflammatory drugs (NSAIDs) and conventional disease-modifying antirheumatic drugs (DMARDs) fail to provide adequate relief, biologic therapies like Cosentyx may be recommended. Cosentyx has been shown to reduce inflammation and improve physical function, which can aid in faster recovery and potentially lower the risk of permanent work restrictions or total disability claims. However, while effective, it is important to carefully monitor the potential side effects associated with Cosentyx.
Common side effects include:
- Upper respiratory tract infections
- Headaches
- Diarrhea
- Cold-like symptoms
More serious but less common side effects can include:
- Risk of severe infections
- Allergic reactions
- Exacerbation of pre-existing Crohn’s disease
Due to these potential side effects, it’s essential for health care providers to conduct thorough pre-treatment assessments and ongoing monitoring. For patients under workers' compensation, this may involve coordination between treating physicians, claims adjusters and pharmacy benefit managers (PBMs) to ensure comprehensive care management.
The cost of biologic treatments like Cosentyx is a significant factor in the workers’ compensation industry, with the average wholesale price (AWP) ranging from $4,400 to $8,900 per month, depending on the dosing regimen. This high cost presents challenges for insurers and employers, who must balance the medication's potential benefits against its financial impact. Insurance plans often require prior authorization for such expensive treatments, adding complexity to the process. However, the long-term benefits, such as reduced overall health care costs through fewer emergency room visits and improved work productivity, can help offset the initial expense.
There are several alternatives to Cosentyx that may be considered for patients with autoimmune conditions under workers’ compensation claims:
- Other Biologic Agents:
- Humira (adalimumab): A tumor necrosis factor (TNF) inhibitor, commonly used for similar indications. It’s a well-established safety profile but differs in its mechanism of action. (AWP $600 – $9,900 per month)
- Enbrel (etanercept): Another TNF inhibitor, which may be preferred based on patient-specific factors and insurance coverage. (AWP $1,800 – $2,300 per month)
- Janus Kinase (JAK) Inhibitors:
- Xeljanz (tofacitinib): An oral medication that inhibits the JAK pathway, which is involved in the immune response. It can be used in patients who prefer oral administration over injections. (AWP $6,900 per month)
- Traditional DMARDs:
- Methotrexate: An older, more cost-effective option that’s often used as a first-line treatment. While it’s less effective than biologics for some patients, it may still be beneficial when combined with other therapies. (AWP $10 – $50 per month)
Cosentyx offers a viable treatment option for managing chronic autoimmune conditions in the workers' compensation sector, effectively alleviating severe joint pain and inflammation. However, its high cost and potential side effects complicate its use. Therefore, the decision to incorporate Cosentyx into treatment plans requires a careful analysis of clinical outcomes, financial implications and patient-specific needs. Collaboration among employers, insurers and health care providers is essential to ensure the availability of effective and economical treatments, striking a balance between recovery goals and cost management.
This information is meant to serve as a general overview, and any specific questions should be fully reviewed with your health care professional such as the prescribing doctor or dispensing pharmacist.
Do you have a workers’ compensation or auto-related pharmacy question? Send us an email at AskThePharmacist@enlyte.com.
To read more Ask The Pharmacist articles, please visit enlyte.com/ask-the-pharmacist.
References:
www.accessdata.fda.gov/drugsatfda_docs/label/2016/125504s001s002lbl.pdf
https://pmc.ncbi.nlm.nih.gov/articles/PMC2706169/
https://www.psoriasis.org/biologics/