Will TNF Inhibitors Work for You? This Blood Test Will Let You Know

The PrismRA test can help detect whether TNF inhibitors will be an effective treatment for you. Transparency about cost has been difficult, but having this test earlier could have saved me years of heartache.

There’s a blood test that can help rheumatologists and those living with rheumatoid arthritis (RA) make an informed decision about a potential treatment option.

It’s called the PrismRA molecular signature test. It can help determine if a group of medications called TNF inhibitors are likely to work for you, as someone living with RA.

TNF inhibitors refer to tumor necrosis factor inhibitors and are a type of biologic. They’re also commonly called TNF-alpha inhibitors, TNF blockers, or anti-TNF drugs.

They’re one of the most commonly prescribed medications for RA. Some that you might know by brand name include Cimzia, Humira, Enbrel, and Simponi.

Rather than the usual trial and error medication game, knowing how likely a specific treatment might actually help you is like … well, magic. It’s precision medicine in action!

So, let me tell you about my experience with the PrismRA test.

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Trying and failing RA medications

I have tried five different medications to treat my RA, including three TNF inhibitor medications. So far, I have yet to find a treatment that works for me. This process has been time-consuming, stressful, costly, and disheartening.

Each time I start a new medication, I go through the process of researching potential side effects, finding out if my insurance will cover the medication, and applying for additional financial assistance through programs offered by the drug manufacturer.

Once I receive the medication, I teach myself how to administer it with the hopes that I will not have an allergic reaction and will be able to tolerate it.

If my body does tolerate the medication, it then becomes a waiting game to see if I notice any improvement in symptoms which can take several months. It’s an arduous process accompanied by a roller coaster of emotions and does not always lead to a successful treatment plan.

I’m not alone in my experience. In fact, a 2019 study found that 75% of RA patients are not satisfied with treatments.

My rheumatologist recommended I get the PrismRA test

After trying Enbrel — a common TNF inhibitor — for 6 months without noticing any improvement in my RA symptoms, my rheumatologist mentioned the PrismRA test. She wanted to know whether I was even a good candidate for TNF inhibitors.

“I’m not convinced that TNF inhibitors work for you,” she pointed out. I agreed and was sent to have blood drawn for the test. I also made a follow-up appointment with my rheumatologist for her to discuss the results.

The PrismRA test comes as a full kit in a small box. The phlebotomist asked me several questions to fill out the paperwork and also mentioned that the kit requires a physician’s signature. Three tubes of blood were drawn for the test.

Once the PrismRA test has been sent to the lab, your rheumatologist should receive the results within 5–7 business days.

Understanding the PrismRA test results

The PrismRA results show whether an inadequate response to TNF inhibitors is detected. The test provides a score reported on a scale from 1–25. The higher the score, the more likely you are to have an inadequate response to TNF inhibitor treatments.

There are three score interpretations:

• A score greater than 18.5 is considered a very high signal of inadequate response. It means a patient only has a 5% chance of responding to TNF inhibitors.
• A score greater than 10.6 shows a high signal of inadequate response, with a 10% chance of responding to TNF inhibitors.
• A score less than 10.6 indicates that no signal of inadequate response is detected. This means that a patient may likely respond to TNF inhibitors.

My test results helped validate my RA treatment experience

At my follow-up appointment, my rheumatologist shared the results of my PrismRA test. I received a score of 14.9, correlating with a high signal of inadequate response, meaning only a 10% chance that TNF inhibitors would work for me.

My rheumatologist explained that the Enbrel I had been taking for 6 months may still have slowed some joint erosion and disease progression, but that the results confirmed why I had not been experiencing any relief of day-to-day symptoms.

We concluded that TNF inhibitor therapy isn’t the best treatment plan for me. Given that I’d taken three different TNF inhibitor medications with few results and a plethora of frustrating side effects, the results from the PrismRA test felt validating.

I also felt some grief over the time and money spent on medications that my body was unlikely to ever respond to. All the allergies, side effects, and heartbreak now seemed like a kick in the teeth. But, care provisions change and this test gave me some much-needed answers.

How much does the PrismRA test cost?

According to Scipher Medicine, most patients with insurance should expect to pay less than $75 for the test.

However — as I found out — the test without insurance is $4,995.00

If it’s anticipated that the cost will be more than $75, Scipher Medicine states that you will receive a call to review the estimated costs.

A financial assistance program with financing options is also available through Scipher Medicine.

In addition, there are a few nonprofit co-pay foundations that offer grants to assist patients with RA. For example, you might try the PAN Foundation, the HealthWell Foundation, or Accessia Health.

The funds may not be open, especially later in the calendar year due to high demand, but there are several different resources to try.

It’s also thought that Medicare will cover some of the costs of this test, but without a secondary health insurance, you’d expect to still be out of pocket.

My insurance was billed for the cost of the test. However, about a month after the test, my insurance company told me the claim was denied. This was a big surprise.

I called Scipher Medicine, and they explained that the request hadn’t been officially denied yet, but the insurance company required more documentation. They told me that it’s not uncommon for insurance companies to initially reject covering the test, but that they work hard to appeal a denied claim on a patient’s behalf, and they often have success. So, I’m still hopeful that my insurance will cover the cost of the test.

If they don’t, I will go through Scipher Medicine’s financial assistance programs, which they explained will provide interest-free payment plans. However, it’s still unclear to me how much of the cost an uninsured patient would be responsible for.

This was something I was not expecting and is definitely a downside of the test. I was also very frustrated that this potential cost was only highlighted once the test was ordered and performed.

How much could the PrismRA test save us?

Ironically … PrismRA has the potential to save insurers and patients thousands of dollars a year from unnecessary healthcare costs.

According to a 2020 study, implementing the PrismRA test could save over $7 million in overall healthcare costs for every 1,000 patients tested. If all 1.6 million people living with RA in the United States were tested, it could save over $10 billion. Just let that sink in. $10 billion of unnecessary healthcare costs saved.

Of course, there’s an increasing number of biosimilars available, which are drugs that are very similar to the generic more well-known drugs. These are often less expensive. So, the financial savings reported may be overstated, but there are still lots of benefits.

Beyond the financial costs, it can benefit our treatment, disease progression, mental health, and quality of life. This 2022 study found that patients who used a test like PrismRA were three times more likely to reach remission.

This is the potential — and now possible reality — of precision medicine in healthcare.

Precision medicine is no longer on the horizon — it’s here

The PrismRA test is one example of using precision medicine to help us reach our treatment goals. It can tell us whether TNF inhibitors will be an effective treatment option.

I can’t believe the years I spent trying different TNF inhibitors. The constant hope and eventual heartbreaks I endured.

Usually, if a patient doesn’t respond to one TNF inhibitor, another isn’t tried, but a switch to a different treatment option should be recommended. For the same reason, rheumatologists might not consider the PrismRA test for their patients if one TNF inhibitor wasn’t effective.

But, this wasn’t my experience, and I tried several. With few treatment options working for me, the PrismRA test was helpful to have more information to decide my options.

The PrismRA test would have helped me years ago, but I’m so glad that I’ve received it now. It validated some of my experiences and the information it provided helped me and my doctor to make an informed decision to adjust my treatment plan.

The lack of transparency about cost has been difficult, but I do believe that this test has the potential to offer many benefits for those living with RA.