RhAPPcast: From Prescription to Possession: Understanding Medicare Access & Cap and Smooth

RhAPPcast: From Prescription to Possession: Understanding Medicare Access & Cap and Smooth

In this episode of RhAPPcast, the official podcast of the Rheumatology Advanced Practice Providers, host Amanda Mixon, PA-C, is joined by rheumatology experts Heather Finlayson, PA-C, and Stacey Johnson, NP, to discuss one of the most challenging aspects of rheumatology care: ensuring patient access to advanced therapies. This conversation explores the complexities of Medicare formularies, prior authorizations, step edits, tier placement, and evolving affordability programs that support patients receiving specialty medications. Listeners will gain practical insights into how Medicare Part B and Part D coverage impacts rheumatology prescribing, including formulary restrictions, preferred therapies, and the financial barriers patients often face when accessing biologics and biosimilars. The discussion also highlights programs such as the Medicare Prescription Payment Plan (M3P), CAP, and cost-smoothing initiatives that help reduce out-of-pocket costs and improve treatment access for Medicare beneficiaries. The panel also shares practical strategies for navigating access challenges through patient education, strong documentation, communication with clinic teams and biologics coordinators, and proactive advocacy to help patients stay on therapy. Ideal for rheumatology providers, advanced practice providers, pharmacists, and clinic teams, this episode delivers actionable guidance to improve patient access, reduce treatment delays, and support long-term medication adherence in rheumatology practice. For more expert-led rheumatology education, visit the RhAPP Content Rheum and RhAPP ACE app, and subscribe to RhAPPcast for future episodes.

FAQ: What Is Minimal Disease Activity in PsA and How Does Deucravacitinib Perform at 52 Weeks?

In this FAQ video, Christy Vath, PA-C of Seattle Rheumatology Associates, breaks down the concept of minimal disease activity (MDA) in psoriatic arthritis (PsA) and explores how deucravacitinib performs in achieving this important treatment target at 52 weeks. With the evolution of targeted biologic therapies since the late 1990s, treatment goals in PsA have shifted toward objective, measurable outcomes like MDA—an established composite endpoint requiring patients to meet 5 of 7 clinical criteria, including low joint counts, reduced skin involvement, improved patient-reported outcomes, and minimal enthesitis. This educational discussion reviews the development and validation of MDA as a treat-to-target strategy in PsA, highlighting its clinical significance in improving disease control and patient quality of life. Christy also dives into the mechanism of action of deucravacitinib, a selective TYK2 inhibitor that targets key inflammatory pathways such as IL-23 and type 1 interferon, central to PsA pathogenesis. Data from the POETYK PsA-1 and PsA-2 phase 3 trials are discussed, showing that deucravacitinib demonstrated superior MDA response rates compared to placebo at week 16, with continued improvement through week 24 and sustained responses at week 52, reaching nearly 34%. Watch now to better understand MDA in PsA, the role of TYK2 inhibition, and how evolving therapies are helping clinicians achieve meaningful, long-term outcomes for patients. For more rheumatology content, visit the RhAPP Content Rheum or the RhAPP ACE app.

FAQ: What Guideline Recommendations Exist Pertaining to Managing obesity in Patients With PsA?

In this FAQ video, Shannon Ghizzoni, PA-C, of Columbus Arthritis Center reviews the latest guidance on managing obesity in patients with psoriatic arthritis. Referencing the 2018 American College of Rheumatology (ACR) and National Psoriasis Foundation recommendations, she explains why weight loss is conditionally recommended for overweight and obese patients with psoriatic arthritis and how adiposity contributes to systemic inflammation and increased disease activity. This discussion explores evidence behind very low-calorie and hypocaloric diets, the role of the Mediterranean diet in reducing inflammation and cardiovascular risk, and emerging data on gluten-free diets, sugar reduction, and GLP-1 therapies. Designed for rheumatology clinicians and advanced practice providers, this video highlights practical, individualized strategies to support weight management and improve outcomes in psoriatic arthritis.

RhAPPcast: Identification and Diagnosis of XLH: A Story of Family History

In this episode of RhAPPcast, the official podcast of Rheumatology Advanced Practice Providers, host Amanda Mixon and Bonnie Smeryage, NP, explore the real-world impact of X-linked hypophosphatemia (XLH) through a powerful patient perspective. Featuring Shannon Sharp, a patient ambassador with Kyowa Kirin, this discussion dives into the genetic basis, diagnostic challenges, and lifelong burden of XLH—a rare, chronic metabolic bone disorder characterized by renal phosphate wasting. Learn how XLH symptoms such as bone pain, muscle weakness, fractures, and joint stiffness can mimic common rheumatologic conditions, often leading to misdiagnosis. This episode highlights the critical role of family history, genetic testing, and fasting serum phosphorus in identifying XLH, while also emphasizing the importance of compassionate, patient-centered care when discussing sensitive topics like family planning. Gain valuable clinical insights into disease progression, surgical considerations, and quality-of-life challenges, along with practical strategies to improve diagnosis and management. Whether you're a rheumatology provider, advanced practice provider (APP), or healthcare professional, this episode offers essential education on recognizing and supporting patients with XLH.

Medication Review: What Is the Safety Profile of Tirzepatide?

Explore the safety profile of tirzepatide in this clinician-focused medication review led by Bharati Bhardwaja, PharmD, a rheumatology clinical pharmacist at Kaiser Permanente Colorado. This video provides a comprehensive overview of common adverse effects associated with tirzepatide, including gastrointestinal symptoms such as nausea, diarrhea, constipation, abdominal pain, and decreased appetite, as well as other reactions like injection site reactions, fatigue, and hair loss. The discussion also highlights important drug interaction considerations, including the need to adjust doses of insulin or sulfonylureas to reduce hypoglycemia risk, and the impact of delayed gastric emptying on the absorption of medications with narrow therapeutic windows, such as warfarin. Special attention is given to potential considerations with mycophenolate mofetil and oral hormonal contraceptives, along with guidance on monitoring and alternative strategies. Additionally, this review covers key safety considerations for pregnancy and lactation, emphasizing the importance of risk-benefit discussions and appropriate discontinuation when necessary. Designed for healthcare professionals managing patients with metabolic and rheumatologic conditions, this video delivers practical insights to support safe prescribing, minimize adverse effects, and optimize patient outcomes with tirzepatide therapy. Explore more expert-led education and medication reviews on the Content Rheum and stay up to date with the latest clinical insights in rheumatologic care.