Baricitinib for moderate to severe rheumatoid arthritis

Baricitinib (Olumiant, Eli Lilly) has a marketing authorisation in the UK for the 'treatment of moderate to severe active rheumatoid arthritis in adult patients who have responded inadequately to, or who are intolerant to one or more disease-modifying antirheumatic drugs.' Baricitinib can be given as monotherapy or in combination with methotrexate.

The recommended dose of baricitinib is 4 mg once daily. A dose of 2 mg once daily is appropriate for patients aged 75 years and over and may be appropriate for patients with a history of chronic or recurrent infections. A dose of 2 mg once daily may also be considered for patients who have achieved sustained control of disease activity with 4 mg once daily and are eligible for dose-tapering.

The list price of a 28-tablet pack of 2 mg or 4 mg baricitinib is £805.56. Each dose will also be available in 84-tablet packs at a pro-rata price from late 2017.

The average cost per patient per year is estimated at £10,501 based on the list price.

The company has agreed a patient access scheme with the Department of Health. This scheme provides a simple discount to the list price of baricitinib, with the discount applied at the point of purchase or invoice. The level of the discount is commercial in confidence. The Department of Health considered that this patient access scheme does not constitute an excessive administrative burden on the NHS.